US10973834B2 - EP4 inhibitors and use thereof - Google Patents

EP4 inhibitors and use thereof Download PDF

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US10973834B2
US10973834B2 US16/385,524 US201916385524A US10973834B2 US 10973834 B2 US10973834 B2 US 10973834B2 US 201916385524 A US201916385524 A US 201916385524A US 10973834 B2 US10973834 B2 US 10973834B2
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alkoxy
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US20190314390A1 (en
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Mark Manfredi
Jeffrey Ecsedy
Atsushi Nagahisa
Yukinori Take
Takako Okumura
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Askat Inc
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Arrys Therapeutics Inc
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    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
    • A61K31/437—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a five-membered ring having nitrogen as a ring hetero atom, e.g. indolizine, beta-carboline
    • A—HUMAN NECESSITIES
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    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
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    • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
    • A61K39/39541—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against normal tissues, cells
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    • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
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    • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
    • C07K16/2803—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily
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    • C07K2317/24—Immunoglobulins specific features characterized by taxonomic origin containing regions, domains or residues from different species, e.g. chimeric, humanized or veneered

Definitions

  • Prostaglandins are mediators of pain, fever and other symptoms associated with inflammation.
  • Prostaglandin E 2 (PGE 2 ) is the predominant eicosanoid detected in inflammation conditions. In addition, it is also involved in various physiological and/or pathological conditions such as hyperalgesia, uterine contraction, digestive peristalsis, awakeness, suppression of gastric acid secretion, blood pressure, platelet function, bone metabolism, angiogenesis or the like.
  • EP4 subtypes a Gs-coupled receptor
  • PI3K and GSK3 ⁇ signaling a Gs-coupled receptor
  • Various EP4 inhibitors have been described previously, for example, in WO 2002/032900, WO 2005/021508, U.S. Pat. Nos. 6,710,054, and 7,238,714, the contents of which are incorporated herein by reference in their entireties.
  • Immuno-oncology seeks to enlist the body's immune system to combat the growth of malignant tumors. Examples of immuno-oncology agents are discussed, for example, in Nature Reviews Drug Discovery 14 (2015) 603-622 and Bioorganic & Medicinal Chemistry Letters 28 (2016) 319-329, the contents of which are incorporated herein by reference in their entireties.
  • FIG. 1 depicts Growth Kinetics in BALB/C Mice Bearing CT-26 Tumors.
  • BALB/C mice bearing CT-26 tumors were treated with vehicle (0.5% methylcellulose and IgG2a), anti-PD-1, or Compound B at 15 mg/kg QD and BID alone or in combination with anti-PD-1.
  • FIG. 2 depicts Kaplan-Meier Curve of Tumor Bearing Mice.
  • FIG. 3 depicts Tumor Growth Kinetics in BALB/C Mice Bearing 4T1 Tumors.
  • BALB/C mice bearing 4T1 tumors were treated with vehicle, anti-CTLA4, or Compound B at 15 mg/kg BID alone or in combination with anti-CTLA41.
  • FIG. 6 depicts BALB/C mice bearing 4T1 tumors treated with vehicle (0.5% methylcellulose and PBS), anti-PD1, or Compound B at 15 mg/kg BID alone or in combination with anti-PD1.
  • FIG. 7 depicts the immune cell composition of CT-26 tumors grown in BALB/c mice treated with vehicle (0.5% methylcellulose and PBS), anti-PD1, or Compound B (CPD-B) at 15 mg/kg BID alone or in combination with anti-PD1.
  • the percentage of regulatory T cells (a), dendritic cells (b), activated T cells (c) and activated PD-1 high T cells (d) is shown.
  • the present invention provides a method for treating a proliferative disorder in a patient comprising administering to the patient an agent that inhibits prostaglandin EP4 receptor (EP4) activity, and an immuno-oncology agent.
  • an agent that inhibits EP4 activity is a selective EP4 inhibitor.
  • an immuno-oncology agent is a PD-1 inhibitor.
  • a proliferative disorder is as described herein.
  • a proliferative disorder is a NSCLC subject that has been previously treated for more than 12 weeks with any PD-1 or PD-L1 checkpoint inhibitor.
  • a proliferative disorder is a CRC patient who has MSS disease.
  • an agent that inhibits prostaglandin EP4 receptor (EP4) activity is compound A, or a pharmaceutically acceptable salt thereof. In some embodiments, an agent that inhibits prostaglandin EP4 receptor (EP4) activity is compound B, or a pharmaceutically acceptable salt thereof.
  • aliphatic groups contain 1-5 aliphatic carbon atoms. In other embodiments, aliphatic groups contain 1-4 aliphatic carbon atoms. In still other embodiments, aliphatic groups contain 1-3 aliphatic carbon atoms, and in yet other embodiments, aliphatic groups contain 1-2 aliphatic carbon atoms.
  • “cycloaliphatic” (or “carbocycle” or “cycloalkyl”) refers to a monocyclic C 3 -C 6 hydrocarbon that is completely saturated or that contains one or more units of unsaturation, but which is not aromatic, that has a single point of attachment to the rest of the molecule.
  • Suitable aliphatic groups include, but are not limited to, linear or branched, substituted or unsubstituted alkyl, alkenyl, alkynyl groups and hybrids thereof such as (cycloalkyl)alkyl, (cycloalkenyl)alkyl or (cycloalkyl)alkenyl.
  • bicyclic ring or “bicyclic ring system” refers to any bicyclic ring system, i.e. carbocyclic or heterocyclic, saturated or having one or more units of unsaturation, having one or more atoms in common between the two rings of the ring system.
  • the term includes any permissible ring fusion, such as ortho-fused or spirocyclic.
  • heterocyclic is a subset of “bicyclic” that requires that one or more heteroatoms are present in one or both rings of the bicycle.
  • Such heteroatoms may be present at ring junctions and are optionally substituted, and may be selected from nitrogen (including N-oxides), oxygen, sulfur (including oxidized forms such as sulfones and sulfonates), phosphorus (including oxidized forms such as phosphates), boron, etc.
  • a bicyclic group has 7-12 ring members and 0-4 heteroatoms independently selected from nitrogen, oxygen, or sulfur.
  • the term “bridged bicyclic” refers to any bicyclic ring system, i.e. carbocyclic or heterocyclic, saturated or partially unsaturated, having at least one bridge.
  • a “bridge” is an unbranched chain of atoms or an atom or a valence bond connecting two bridgeheads, where a “bridgehead” is any skeletal atom of the ring system which is bonded to three or more skeletal atoms (excluding hydrogen).
  • a bridged bicyclic group has 7-12 ring members and 0-4 heteroatoms independently selected from nitrogen, oxygen, or sulfur.
  • Such bridged bicyclic groups are well known in the art and include those groups set forth below where each group is attached to the rest of the molecule at any substitutable carbon or nitrogen atom.
  • a bridged bicyclic group is optionally substituted with one or more substituents as set forth for aliphatic groups. Additionally or alternatively, any substitutable nitrogen of a bridged bicyclic group is optionally substituted.
  • Exemplary bicyclic rings include:
  • lower alkyl refers to a C 1-4 straight or branched alkyl group.
  • exemplary lower alkyl groups are methyl, ethyl, propyl, isopropyl, butyl, isobutyl, and tert-butyl.
  • lower haloalkyl refers to a C 1-4 straight or branched alkyl group that is substituted with one or more halogen atoms.
  • unsaturated means that a moiety has one or more units of unsaturation.
  • bivalent C 1-8 (or C 1-6 ) saturated or unsaturated, straight or branched, hydrocarbon chain refers to bivalent alkylene, alkenylene, and alkynylene chains that are straight or branched as defined herein.
  • alkylene refers to a bivalent alkyl group.
  • An “alkylene chain” is a polymethylene group, i.e., —(CH 2 ) n —, wherein n is a positive integer, preferably from 1 to 6, from 1 to 4, from 1 to 3, from 1 to 2, or from 2 to 3.
  • a substituted alkylene chain is a polymethylene group in which one or more methylene hydrogen atoms are replaced with a substituent. Suitable substituents include those described below for a substituted aliphatic group.
  • alkenylene refers to a bivalent alkenyl group.
  • a substituted alkenylene chain is a polymethylene group containing at least one double bond in which one or more hydrogen atoms are replaced with a substituent. Suitable substituents include those described below for a substituted aliphatic group.
  • cyclopropylenyl refers to a bivalent cyclopropyl group of the following structure:
  • halogen means F, Cl, Br, or I.
  • aryl used alone or as part of a larger moiety as in “aralkyl,” “aralkoxy,” or “aryloxyalkyl,” refers to monocyclic or bicyclic ring systems having a total of five to fourteen ring members, wherein at least one ring in the system is aromatic and wherein each ring in the system contains 3 to 7 ring members.
  • aryl may be used interchangeably with the term “aryl ring.”
  • aryl refers to an aromatic ring system which includes, but not limited to, phenyl, biphenyl, naphthyl, anthracyl and the like, which may bear one or more substituents.
  • heteroaryl and “heteroar-,” used alone or as part of a larger moiety, e.g., “heteroaralkyl,” or “heteroaralkoxy,” refer to groups having 5 to 10 ring atoms, preferably 5, 6, or 9 ring atoms; having 6, 10, or 14 ⁇ electrons shared in a cyclic array; and having, in addition to carbon atoms, from one to five heteroatoms.
  • heteroatom refers to nitrogen, oxygen, or sulfur, and includes any oxidized form of nitrogen or sulfur, and any quaternized form of a basic nitrogen.
  • heteroaryl and “heteroar-”, as used herein, also include groups in which a heteroaromatic ring is fused to one or more aryl, cycloaliphatic, or heterocyclyl rings, where the radical or point of attachment is on the heteroaromatic ring.
  • Nonlimiting examples include indolyl, isoindolyl, benzothienyl, benzofuranyl, dibenzofuranyl, indazolyl, benzimidazolyl, benzthiazolyl, quinolyl, isoquinolyl, cinnolinyl, phthalazinyl, quinazolinyl, quinoxalinyl, 4H-quinolizinyl, carbazolyl, acridinyl, phenazinyl, phenothiazinyl, phenoxazinyl, tetrahydroquinolinyl, tetrahydroisoquinolinyl, and pyrido[2,3-b]-1,4-oxazin-3(4H)-one.
  • heterocycle As used herein, the terms “heterocycle,” “heterocyclyl,” “heterocyclic radical,” and “heterocyclic ring” are used interchangeably and refer to a stable 5- to 7-membered monocyclic or 7-10-membered bicyclic heterocyclic moiety that is either saturated or partially unsaturated, and having, in addition to carbon atoms, one or more, preferably one to four, heteroatoms, as defined above.
  • nitrogen includes a substituted nitrogen.
  • Each optional substituent on a substitutable carbon is a monovalent substituent independently selected from halogen; —(CH 2 ) 0-4 R ⁇ ; —(CH 2 ) 0-4 OR ⁇ ; —O(CH 2 ) 0-4 R, —O—(CH 2 ) 0-4 C(O)OR ⁇ ; —(CH 2 ) 0-4 CH(OR ⁇ ) 2 ; —(CH 2 ) 0-4 SR ⁇ ; —(CH 2 ) 0-4 Ph, which may be substituted with R ⁇ ; —(CH 2 ) 0-4 O(CH 2 ) 0-1 Ph which may be substituted with R ⁇ ; —CH ⁇ CHPh, which may be substituted with R ⁇ ; —(CH 2 ) 0-4 O(CH 2 ) 0-1 -pyridyl which may be substituted with R ⁇ ; —NO 2 ; —CN; —N 3 ; —(CH
  • Salts derived from appropriate bases include alkali metal, alkaline earth metal, ammonium and N+(C 1-4 alkyl) 4 salts.
  • Representative alkali or alkaline earth metal salts include sodium, lithium, potassium, calcium, magnesium, and the like.
  • Further pharmaceutically acceptable salts include, when appropriate, nontoxic ammonium, quaternary ammonium, and amine cations formed using counterions such as halide, hydroxide, carboxylate, sulfate, phosphate, nitrate, loweralkyl sulfonate and aryl sulfonate.
  • structures depicted herein are also meant to include compounds that differ only in the presence of one or more isotopically enriched atoms.
  • compounds having the present structures including the replacement of hydrogen by deuterium or tritium, or the replacement of a carbon by a 13 C- or 14 C-enriched carbon are within the scope of this invention.
  • Such compounds are useful, for example, as analytical tools, as probes in biological assays, or as therapeutic agents in accordance with the present invention.
  • a warhead moiety, R 1 of a provided compound comprises one or more deuterium atoms.
  • an agent that inhibits EP4 activity refers to an agent that reduces or attenuates the biological activity of an EP4 receptor.
  • agents may include proteins such as anti-EP4 antibodies, nucleic acids, amino acids, peptides carbohydrates, small molecules (organic or inorganic), or any other compound or composition which decreases the activity of an EP4 receptor either by reducing the amount of EP4 receptor present in a cell, or by decreasing the binding or signaling activity of the EP4 receptor.
  • EP4 receptor activity or “EP4 activity” refers to an EP4-mediated increase in cAMP levels upon PGE 2 stimulation.
  • measurable affinity refers to a measurable change in EP4 activity between a sample comprising an EP4 inhibitor described herein, or a salt or a composition thereof, and EP4, and an equivalent sample comprising EP4, in the absence of said compound, or composition thereof.
  • B is halo-substituted C 1-6 alkylene, C 3-7 cycloalkylene, C 2-6 alkenylene, C 2-6 alkynylene, —O—C 1-5 alkylene, C 1-2 alkylene-O—C 1-2 alkylene or C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl;
  • W is NH, N—C 1-4 alkyl, O, S, N—OR 5 or a covalent bond;
  • n 0, 1 or 2;
  • R 3 and R 4 are independently selected from H and C 1-4 alkyl
  • Q 2 is a 5-12 membered monocyclic or bicyclic aromatic ring, or a 5-12 membered tricyclic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-8 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkyl-(O ⁇ )C, R 3 (R 4 )C( ⁇ O)N—,
  • Y 1 , Y 2 , Y 3 and Y 4 are independently selected from N, CH or C(L).
  • Y 1 is N. In some embodiments, Y 1 is CH. In some embodiments, Y 1 is C(L), wherein L is as defined in the embodiments described herein.
  • Y 3 is N. In some embodiments, Y 3 is CH. In some embodiments, Y 3 is C(L), wherein L is as defined in the embodiments described herein.
  • Y 4 is N. In some embodiments, Y 4 is CH. In some embodiments, Y 4 is C(L), wherein L is as defined in the embodiments described herein.
  • Y 1 , Y 2 , Y 3 and Y 4 are selected from:
  • Y 1 and Y 3 are C(L), Y 2 is CH and Y 4 is N;
  • Y 1 , Y 2 and Y 3 are C(L) and Y 4 is N;
  • Y 1 and Y 3 are C(L), Y 2 is N and Y 4 is CH;
  • Y 1 is C(L) and Y 2 , Y 3 and Y 4 are CH;
  • Y 1 , Y 3 and Y 4 are CH, and Y 2 is C(L);
  • Y 1 , Y 2 and Y 3 are CH, and Y 4 is C(L);
  • Y 1 and Y 2 are C(L), and Y 3 and Y 4 are CH;
  • Y 1 and Y 3 are C(L), and Y 2 and Y 4 are CH;
  • Y 1 and Y 4 are CH, and Y 2 and Y 3 are C(L);
  • Y 1 and Y 2 are CH, Y 3 is C(L) and Y 4 is N;
  • Y 1 and Y 3 are CH, Y 2 is C(L) and Y 4 is N;
  • Y 1 , Y 2 , Y 3 and Y 4 are CH;
  • Y 1 and Y 2 are C(L), Y 3 is CH and Y 4 is N;
  • Y 1 , Y 2 and Y 4 are CH, and Y 3 is C(L);
  • Y 1 and Y 2 are C(L), Y 3 is N and Y 4 is CH;
  • Y 1 and Y 3 are C(L), and Y 2 and Y 4 are N;
  • Y 1 is C(L), Y 2 and Y 3 are CH, and Y 4 is N; or
  • Y 2 is C(L), Y 1 and Y 3 are CH, and Y 4 is N.
  • Y 1 and Y 3 are C(L), Y 2 is N and Y 4 is CH;
  • Y 1 and Y 2 are C(L), and Y 3 and Y 4 are CH;
  • Y 1 and Y 3 are C(L), and Y 2 and Y 4 are CH; or
  • R 1 is H, C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 3-7 cycloalkyl, C 1-8 alkoxy, halo-substituted C 1-8 alkoxy, C 1-8 alkyl-S(O)m-, Q 1 -, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, amino, mono- or di-(C 1-8 alkyl)amino, C 1-4 alkyl-C( ⁇ O)—N(R 3 )— or C 1-4 alkyl-S(O)m-N(R 3 )—, wherein said C 1-8 alkyl, C 2-8 alkenyl and C 2-8 alkynyl are optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3
  • R 1 is C 1-8 alkyl, optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cycloalkyl-, cyano, indanyl, 1,2,3,4-tetrahydronaphtyl, 1,2-dihydronaphtyl, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, Q 1 -C( ⁇ O)—, Q 1 -O—, Q 1 -S(O)m-, Q-C 1-4 alkyl-O—, Q-C 1-4 alkyl-S(O)m-, Q 1 -C 1-4 alkyl-C(O)—N(R 3 )—, Q 1 -C 1-4 alkyl-N(R 3 )— or C 1-4 alkyl
  • R 1 is C 2-8 alkenyl, optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cycloalkyl-, cyano, indanyl, 1,2,3,4-tetrahydronaphtyl, 1,2-dihydronaphtyl, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, Q 1 -C( ⁇ O)—, Q 1 -O—, Q 1 -S(O)m-, Q 1 -C 1-4 alkyl-O—, Q 1 -C 1-4 alkyl-S(O)m-, Q 1 -C 1-4 alkyl-C(O)—N(R 3 )—, Q 1 -C 1-4 alkyl-N(R 3 )— or C
  • R 1 is C 2-8 alkynyl, optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cycloalkyl-, cyano, indanyl, 1,2,3,4-tetrahydronaphtyl, 1,2-dihydronaphtyl, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, Q 1 -C( ⁇ O)—, Q 1 -O—, Q 1 -S(O)m-, Q 1 -C 1-4 alkyl-O—, Q 1 -C 1-4 alkyl-S(O)m-, Q 1 -C 1-4 alkyl-C(O)—N(R 3 )—, Q 1 -C 1-4 alkyl-N(R 3 )— or
  • R 1 is C 1-5 alkyl or C 3-7 cycloalkyl, wherein said C 1-5 alkyl is optionally substituted with C 1-3 alkyl, hydroxy, oxo, pynolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, or C 1-4 alkyl-C(O)—N(H)—, wherein Q 1 is as defined in the embodiments described herein.
  • R 1 is C 1-5 alkyl optionally substituted with C 1-3 alkyl, hydroxy, oxo, 5 or 6 membered monocyclic aromatic ring, wherein said 5 or 6 membered monocyclic aromatic ring is containing 1 or 2 heteroatoms selected from N and S, or C 1-4 alkyl-C(O)—N(R 3 )—, wherein R 3 is as defined in the embodiments described herein.
  • R 1 is C 3-7 cycloalkyl.
  • R 1 is C 1-8 alkoxy.
  • R 1 is halo-substituted C 1-8 alkoxy.
  • R 1 is C 1-8 alkyl-S(O)m-, wherein m is as defined in the embodiments described herein.
  • R 1 is Q 1 -, wherein Q 1 is as defined in the embodiments described herein.
  • R 1 is pyrrolidinyl
  • R 1 is piperidyl
  • R 1 is oxopyrrolidinyl.
  • R 1 is oxopiperidyl
  • R 1 is amino
  • R 1 is mono- or di-(C 1-8 alkyl)amino.
  • R 1 is C 1-4 alkyl-C( ⁇ O)—N(R 3 )—, wherein R 3 is as defined in the embodiments described herein.
  • R 1 is C 1-4 alkyl-S(O)m-N(R 3 )—, wherein each of m and R 3 is as defined in the embodiments described herein.
  • R 1 is methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, neopentyl, thiazolylethyl methylamino, dimethylamino, pyrrolidinyl, pyridyl, or 1-acetylamino-1-methylethyl.
  • R 1 is selected from those depicted in Table 1.
  • Q 1 is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycl
  • Q 1 is a 5-12 membered monocyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl
  • Q 1 is a 5 or 6 membered monocyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalky
  • Q 1 is a 5-12 membered bicyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl
  • Q 1 is a 8-10 membered bicyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl
  • Q 1 is a 5-12 membered monocyclic aromatic ring optionally containing up to 4 heteroatoms selected from N and S, and is optionally substituted with halo, C 1-4 alkyl, C 1-4 alkylsulfonyl or C 1-4 alkylC( ⁇ O)—.
  • Q 1 is 5-12 membered monocyclic aromatic ring system optionally containing up to 2 heteroatoms selected from N and S.
  • Q 1 is a 5 or 6 membered monocyclic aromatic ring optionally containing up to 4 heteroatoms selected from N and S.
  • Q 1 is selected from those depicted in Table 1.
  • A is a 5-6 membered monocyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-6 membered monocyclic aromatic ring is optionally substituted with up to 3 substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfony
  • A is a 5 membered monocyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5 membered monocyclic aromatic ring is optionally substituted with up to 3 substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamin
  • A is a 6 membered monocyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 6 membered monocyclic aromatic ring is optionally substituted with up to 3 substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamin
  • A is a 5-6 membered monocyclic aromatic ring optionally containing up to 2 heteroatoms selected from O, N, and S, wherein said 5-6 membered monocyclic aromatic ring is optionally substituted with up to 2 substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy and halo-substituted C 1-4 alkoxy.
  • A is 5-6 membered monocyclic aromatic ring optionally substituted with halo, C 1-4 alkyl or C 1-4 alkoxy.
  • A is 5-6 membered monocyclic aromatic ring optionally substituted with halo or C 1-4 alkyl.
  • A is 5-6 membered monocyclic aromatic ring.
  • A is phenyl
  • A is selected from those depicted in Table 1.
  • B is halo-substituted C 1-6 alkylene, C 3-7 cycloalkylene, C 2-6 alkenylene, C 2-6 alkynylene, —O—C 1-5 alkylene, C 1-2 alkylene-O—C 1-2 alkylene or C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is halo-substituted C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 3-7 cycloalkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 2-6 alkenylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 2-6 alkynylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is —O—C 1-5 alkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 1-2 alkylene-O—C 1-2 alkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 3-7 cycloalkylene or C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl.
  • B is C 1-3 alkylene optionally substituted with C 1-3 alkyl.
  • B is C 1-2 alkylene optionally substituted with methyl.
  • B is ethylene or propylene.
  • B is selected from those depicted in Table 1.
  • W is NH, N—C 1-4 alkyl, O, S, N—OR 5 or a covalent bond.
  • W is NH, N—C 1-4 alkyl, O or N—OH.
  • W is NH, N—CH 3 or O.
  • W is NH
  • W is N—C 1-4 alkyl.
  • W is O.
  • W is S.
  • W is N—OR 5 , wherein R 5 is as defined in the embodiments described herein.
  • W is a covalent bond.
  • W is selected from those depicted in Table 1.
  • R 2 is H, C 1-4 alkyl, OH or C 1-4 alkoxy.
  • R 2 is H. In some embodiments, R 2 is C 1-4 alkyl, OH or C 1-4 alkoxy.
  • R 2 is H or C 1-4 alkyl.
  • R 2 is OH
  • R 2 is or C 1-4 alkoxy.
  • R 2 is selected from those depicted in Table 1.
  • Z is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C, C 1-4
  • Z is a 5 membered monocyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5 membered monocyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C, C 1-4 alkyl-O(O ⁇ )C
  • Z is a 6 membered monocyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 6 membered monocyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C, C 1-4 alkyl-O(O ⁇ )C
  • Z is a 8 membered bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 8 membered bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C, C 1-4 alkyl-O(O ⁇ )C
  • Z is a 9 membered bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 9 membered bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C, C 1-4 alkyl-O(O ⁇ )C
  • Z is a 10 membered bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 10 membered bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C, C 1-4 alkyl-O(O ⁇ )C
  • Z is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, hydroxy, C 1-4 alkoxy, nitro, amino, cyano, HO—C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C-C 1-4 alkylsulfonylamino, C 1-4 alkyl-C( ⁇ O)NH—, Q 2 -S(O)m-, Q 2 -O—, Q 2 -N
  • Z is 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkoxy, nitro, amino, cyano, R 3 C( ⁇ O)N(R 4 )—, C 1-4 alkyl-O(O ⁇ )C—, Q 2 -S(O)m-, Q 2 -O—, Q 2 -N(R 3 )— or Q 2 -, wherein each of R 3 , R 4 , Q 2 , and m is independently as defined in the embodiments described herein.
  • Z is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkoxy, nitro, amino, cyano, R 3 C( ⁇ O)N(R 4 )—, C 1-4 alkyl-O(O ⁇ )C, Q 2 -S(O)m-, Q 2 -O—, Q 2 -N(R 3 )— or Q 2 -, wherein each of R 3 , R 4 , Q 2 , and m is independently as defined in the embodiments described herein.
  • Z is 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from N and S, wherein said 5-12 membered monocyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, nitro, R 3 C( ⁇ O)N(R 4 )— or Q 2 -, wherein each of R 3 , R 4 , and Q 2 is independently as defined in the embodiments described herein.
  • Z is 5-10 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from N and S, wherein said 5-10 membered monocyclic aromatic ring is optionally substituted with chloro, bromo, methyl, nitro, CH 3 C( ⁇ O)NH—, tBuC( ⁇ O)NH— or phenyl.
  • Z is phenyl, pyrazolyl, thiazolyl, thiadiazolyl, thienyl, naphthyl or benzothienyl, said phenyl, pyrazolyl, thiazolyl, thiadiazolyl and thienyl being optionally substituted with one to three substituents independently selected from chloro, bromo, methyl, acetylamino, pivaloylamino, nitro and phenyl.
  • Z is selected from those depicted in Table 1.
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl, R 3 C( ⁇ O)N(R 4 )—, NH 2 (HN ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, R 3 N(R 4 )S(O)
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, mono- or di-(C 1-4 alkyl)amino, halo-substituted C 1-4 alkoxy, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl, R 3 C( ⁇ O)N(R 4 )—, R 3 N(R 4 )C( ⁇ O)—, R 3 N(R 4 )S(O)m-, Q 2 -, Q 2 -C( ⁇ O)—, Q 2 -O—
  • L is halo. In some embodiments, L is F. In some embodiments, L is Cl. In some embodiments, L is Br. In some embodiments, L is I.
  • L is C 1-4 alkyl.
  • L is halo-substituted C 1-4 alkyl.
  • L is hydroxyl
  • L is C 1-4 alkoxy.
  • L is halo-substituted C 1-4 alkoxy.
  • L is C 1-4 alkylthio.
  • L is nitro
  • L is amino
  • L is mono- or di-(C 1-4 alkyl)amino.
  • L is cyano
  • L is HO—C- 1-4 alkyl.
  • L is C 1-4 alkoxy-C 1-4 alkyl.
  • L is C 1-4 alkylsulfonyl.
  • L is aminosulfonyl
  • L is C 1-4 alkylC( ⁇ O)—.
  • L is HO(O ⁇ )C—.
  • L is C 1-4 alkyl-O(O ⁇ )C—.
  • L is C 1-4 alkylsulfonylamino.
  • L is C 3-7 cycloalkyl.
  • L is R 3 C( ⁇ O)N(R 4 )—, wherein each of R 3 and R 4 is independently as defined in the embodiments described herein.
  • L is NH 2 (HN ⁇ )C—.
  • L is R 3 N(R 4 )C( ⁇ O)—, wherein each of R 3 and R 4 is independently as defined in the embodiments described herein.
  • L is R 3 N(R 4 )S(O)m-, wherein each of R 3 , R 4 , and m is independently as defined in the embodiments described herein.
  • L is Q 2 -, wherein Q 2 is as defined in the embodiments described herein.
  • L is Q 2 -C( ⁇ O)—, wherein Q 2 is as defined in the embodiments described herein.
  • L is Q 2 -O—, wherein Q 2 is as defined in the embodiments described herein.
  • L is Q 2 -C 1-4 alkyl-O—, wherein Q 2 is as defined in the embodiments described herein.
  • two adjacent L groups are optionally joined together to form an alkylene chain having 3 or 4 members in which one or two (non-adjacent) carbon atoms are optionally replaced by oxygen atoms.
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, cyano, HO—C 1-4 alkyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, R 3 N(R 4 )S(O)m-, Q 2 -, Q 2 -C( ⁇ O)—, or two adjacent L groups are joined together to form a methylenedioxy group, wherein each of R 3 , R 4 , Q 2 , and m is independently as defined in the embodiments described herein.
  • L is chloro, methyl, trifuluoromethyl, hydroxy, methoxy, cyano, acetyl, —C( ⁇ O)NH 2 , trifuluoromethyloxy, methanesulfonyl, or 1-hydroxy-1-methyl-ethyl, or two adjacent L groups are joined together to form a methylenedioxy group.
  • L is selected from those depicted in Table 1.
  • n 0, 1 or 2.
  • m is 0 or 2.
  • n is 0. In some embodiments, m is 1. In some embodiments, m is 2.
  • m is selected from those depicted in Table 1.
  • each of R 3 and R 4 is independently selected from H and C 1-4 alkyl.
  • R 3 is H.
  • R 3 is C 1-4 alkyl
  • R 4 is H.
  • R 4 is C 1-4 alkyl
  • each of R 3 and R 4 is independently selected from those depicted in Table 1.
  • R 5 is H, C 1-4 alkyl, C 1-4 alkyl-(O ⁇ )C— or C 1-4 alkyl-O—(O ⁇ )C—.
  • R 5 is H.
  • R 5 is C 1-4 alkyl.
  • R 5 is C 1-4 alkyl-(O ⁇ )C—.
  • R 5 is C 1-4 alkyl-O—(O ⁇ )C—.
  • R 5 is selected from those depicted in Table 1.
  • Q 2 is a 5-12 membered monocyclic or bicyclic aromatic ring, or a 8-12 membered tricyclic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkyl-(O ⁇ )C—, R 3 (R 4 )C( ⁇ O)N—,
  • Q 2 is a 5-12 membered monocyclic or bicyclic aromatic ring, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-8 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkyl-(O ⁇ )C, R 3 (R 4 )C( ⁇ O)N—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4
  • Q 2 is a 5 or 6 membered monocyclic aromatic ring, wherein said 5 or 6 membered monocyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-8 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkyl-(O ⁇ )C, R 3 (R 4 )C( ⁇ O)N—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulf
  • Q 2 is a 5-12 membered tricyclic ring optionally containing up to 3 heteroatoms selected from O, N and S.
  • Q 2 is a 5 or 6 membered monocyclic aromatic ring or a 8-12 membered tricyclic ring optionally containing 1 sulfur atom wherein said 5 or 6 membered mono cyclic aromatic ring is optionally substituted with halo.
  • Q 2 is a 5 or 6 membered monocyclic aromatic ring.
  • Q 2 is selected from those as depicted in Table 1.
  • a compound of formula I is a compound depicted in Table 1, or a pharmaceutically acceptable salt thereof.
  • an agent that inhibits EP4 activity is compound A:
  • polymorph Form A of compound A is characterised by differential scanning calorimetry (DSC) in which it exhibits an endothermic event at about 160° C.
  • DSC differential scanning calorimetry
  • polymorph Form A of compound A exhibits an X-ray powder diffraction pattern having characteristic peaks expressed in degrees 2-theta at about 9.9, about 13.5, about 14.3, about 16.1, about 17.7, about 21.8, about 24.14, and about 25.8.
  • polymorph Form A of compound A exhibits a differential scanning calorimetry profile having showed an endotherm/exotherm at about 155-170° C.
  • polymorph Form A of compound A exhibits a thermogravimetric analysis showing a loss of mass of 0.5-0.6% when heated from about 30° to about 150° C.
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein:
  • Y 1 , Y 2 , Y 3 and Y 4 is N and the others are independently selected from CH and C(L);
  • R 1 is H, C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 3-7 cycloalkyl, C 1-8 alkoxy, halo-substituted C 1-8 alkoxy, C 1-8 alkyl-S(O)m-, Q 1 -, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, amino, mono- or di-(C 1-8 alkyl)amino, C 1-4 alkyl-C( ⁇ O)—N(R 3 )— or C 1-4 alkyl-S(O)m-N(R 3 )—, wherein said C 1-8 alkyl, C 2-8 alkenyl and C 2-8 alkynyl are optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cyclo
  • Q 1 is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl
  • A is a 5-6 membered monocyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-6 membered monocyclic aromatic ring is optionally substituted with up to 3 substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino,
  • R 2 is H, C 1-4 alkyl, OH or C 1-4 alkoxy
  • Z is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, C 1-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C—, C 1-4 alkyl
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl, R 3 C( ⁇ O)N(R 4 )—, NH 2 (HN ⁇ )C—,
  • n 0, 1 or 2;
  • R 3 and R 4 are independently selected from H and C 1-4 alkyl
  • Q 2 is a 5-12 membered monocyclic or bicyclic aromatic ring, or a 5-12 membered tricyclic ring optionally containing up to 3 heteroatoms selected from O, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 2-4 alkenyl, C 2-4 alkynyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkyl-(O ⁇ )C—, R 3 (R 4 )C( ⁇ O)N—
  • Y 1 , Y 2 , Y 3 , and Y 4 is N and the others are independently selected from CH and C(L);
  • R 1 is H, C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 3-7 cycloalkyl, C 1-8 alkoxy, halo-substituted C 1-8 alkoxy, C 1-8 alkyl-S(O)m-, Q 1 -, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, amino, mono- or di-(C 1-8 alkyl)amino, C 1-4 alkyl-C( ⁇ O)—N(R 3 )— or C 1-4 alkyl-S(O)m-N(R 3 )—, wherein said C 1-8 alkyl, C 2-8 alkenyl and C 2-8 alkynyl are optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cyclo
  • Q 1 is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O)C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl,
  • A is a 5-6 membered monocyclic aromatic ring optionally containing up to 2 heteroatoms selected from O, N, and S, wherein said 5-6 membered monocyclic aromatic ring is optionally substituted with up to 2 substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy and halo-substituted C 1-4 alkoxy;
  • B is C 3-7 cycloalkylene or C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl;
  • W is NH, N—C 1-4 alkyl, O or N—OH;
  • R 2 is H or C 1-4 alkyl
  • Z is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from, N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 1-4 alkenyl, hydroxy, C 1-4 alkoxy, nitro, amino, cyano, HO—C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, R 3 C( ⁇ O)N(R 4 )—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 1-4 alkyl-C( ⁇ O)NH—, Q 2 -S(O)m-, Q 2 -O—, Q 2 -N(R 3
  • R 3 and R 4 are independently selected from H and C 1-4 alkyl
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein:
  • one of Y 1 , Y 2 , Y 3 , and Y 4 is N and the other are independently selected from CH and C(L);
  • R 1 is H, C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 3-7 cycloalkyl, Q 1 -, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, amino, mono- or di-(C 1-8 alkyl)amino, wherein said C 1-8 alkyl is optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cycloalkyl-, cyano, indanyl, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, Q 1 -C(O)—, Q 1 -O—, Q 1 -S—, Q 1 -C 1-4 alkyl-O—, or C 1-4 alky
  • Q 1 is a 5-12 membered monocyclic aromatic ring optionally containing up to 4 heteroatoms selected from N and S, and is optionally substituted with halo, C 1-4 alkyl, C 1-4 alkylsulfonyl and C 1-4 alkylC( ⁇ O)—;
  • W is NH, N—C 1-4 alkyl, O or N—OH;
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl, R 3 C( ⁇ O)N(R 4 )—, R 3 N(R 4 )C( ⁇ O)—, R 3 N(R 4 )S( ⁇ O)m-, Q 2 -, Q 2 -C( ⁇ O)—, Q 2 -O—, Q 2 -C 1-4 alkyl-O—, or two
  • n 0 or 2;
  • R 3 and R 4 are independently selected from H and C 1-4 alkyl
  • Q 2 is a 5 or 6 membered monocyclic aromatic ring, or a 8-12 membered tricyclic ring containing up to 3 heteroatoms selected from N and S, wherein said 5 or 6 membered monocyclic aromatic ring is optionally substituted with halo.
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein:
  • Y 1 , Y 2 , Y 3 and Y 4 is N and the others are independently selected from CH and C(L);
  • R 1 is H, C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl or C 3-7 cycloalkyl, wherein said C 1-8 alkyl is optionally substituted with halo, C 1-3 alkyl, hydroxy, oxo, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cycloalkyl-, cyano, indanyl, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, Q 1 -C( ⁇ O)—, Q 1 -O—, Q 1 -S—, Q 1 -C 1-4 alkyl-O—, or C 1-4 alkyl-C(O)—N(R 3 )—;
  • Q 1 is a 5 or 6 membered monocyclic aromatic ring optionally containing up to 4 heteroatoms selected from N and S;
  • A is 5-6 membered monocyclic aromatic ring system optionally substituted with halo or C 1-4 alkyl;
  • B is C 3-7 cycloalkylene or C 1-6 alkylene optionally substituted with an oxo group or C 1-3 alkyl;
  • W is NH, N—C 1-4 alkyl, O or N—OH;
  • R 2 is H or C 1-4 alkyl
  • Z is 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from N and S, wherein said 5-12 membered monocyclic or bicyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, C 2-4 alkenyl, C 1-4 alkoxy, nitro, amino, cyano, R 3 C( ⁇ O)N(R 4 )—, C 1-4 alkyl-O(O ⁇ )C—, Q 2 -S(O)m-, Q 2 -O—, Q 2 -N(R 3 )— or Q 2 -;
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, cyano, HO—C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O), HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl, R 3 C( ⁇ O)NR 4 —, R 3 N(R 4 )C( ⁇ O)—, R 3 N(R 4 )S(O)m-, Q 2 -, Q 2 -C( ⁇ O)—, Q 2 -O—, Q 2 -C 1-4 alkyl-O—, or two adjacent L groups are optionally joined together to form an alkylene chain having 3 or 4 members in which one
  • n 0 or 2;
  • R 3 and R 4 are independently selected from H and C 1-4 alkyl
  • Q 2 is 5 or 6 membered monocyclic aromatic ring or a 8-12 membered tricyclic ring optionally containing 1 sulfur atom wherein said 5 or 6 membered monocyclic aromatic ring is optionally substituted with halo.
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein:
  • Y 1 , Y 2 , Y 3 and Y 4 is N and the others are independently selected from CH and C(L);
  • R 1 is C 1-5 alkyl or C 3-7 cycloalkyl, wherein said C 1-5 alkyl is optionally substituted with C 1-3 alkyl, hydroxy, oxo, pyrrolidinyl, piperidyl, oxopyrrolidinyl, oxopiperidyl, Q 1 -, or C 1-4 alkyl-C(O)—N(H)—;
  • Q 1 is 5-12 membered monocyclic aromatic ring system optionally containing up to 2 heteroatoms selected from N and S,
  • A is 5-6 membered monocyclic aromatic ring system
  • B is C 1-3 alkylene optionally substituted with C 1-3 alkyl
  • W is NH, N—C 1-2 alkyl or O
  • R 2 is H
  • Z is 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from N and S, wherein said 5-12 membered monocyclic aromatic ring is optionally substituted with halo, C 1-4 alkyl, nitro, R 3 C( ⁇ O)N(R 4 )— or Q 2 -;
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, cyano, HO—C 1-4 alkyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, R 3 N(R 4 )S(O)m-, Q 2 -, Q 2 C( ⁇ O)—, or two adjacent L groups are joined together to form a methylenedioxy group;
  • R 3 and R 4 are independently selected from H and C 1-4 alkyl
  • Q 2 is 5 or 6 membered monocyclic aromatic ring system.
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein:
  • Y 1 , Y 2 , Y 3 and Y 4 is N and the others are independently selected from CH and C-L;
  • R 1 is C 1-5 alkyl optionally substituted with C 1-3 alkyl, hydroxy, oxo, 5 or 6 membered monocyclic aromatic ring, wherein said 5 or 6 membered monocyclic aromatic ring is containing 1 or 2 heteroatoms selected from N and S, or C 1-4 alkyl-C(O)—N(R 3 )—;
  • A is phenyl
  • B is C 1-2 alkylene optionally substituted with methyl
  • W is NH, N—CH 3 or O
  • R 2 is H
  • Z is 5-10 membered monocyclic or bicyclic aromatic ring optionally containing up to 3 heteroatoms selected from N and S, wherein said 5-10 membered monocyclic aromatic ring is optionally substituted with chloro, bromo, methyl, nitro, CH 3 C( ⁇ O)NH—, tBuC( ⁇ O)NH— or phenyl; and
  • L is chloro, methyl, trifluoromethyl, hydroxy, methoxy, cyano, acetyl, —C( ⁇ O)NH 2 , trifuluoramethyloxy, methanesulfonyl, or 1-hydroxy-1-methyl-ethyl, or two adjacent L groups are joined together to form a methylenedioxy group.
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein:
  • Y 1 , Y 2 , Y 3 and Y 4 is N and the others are independently selected from CH and C-(L);
  • R 1 is methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, neopentyl, thiazolylethyl methylamino, dimethylamino, pyrrolidinyl, pyridyl, or 1-acetylamino-1-methylethyl;
  • A is phenyl
  • B is ethylene or propylene
  • W is NH, N—CH 3 or O
  • R 2 is H
  • Z is phenyl, pyrazolyl, thiazolyl, thiadiazolyl, thienyl, naphthyl or benzothienyl, said phenyl, pyrazolyl, thiazolyl, thiadiazolyl and thienyl being optionally substituted with one to three substituents independently selected from chloro, bromo, methyl, acetylamino, pivaloylamino, nitro and phenyl; and L is chloro, methyl, trifluoromethyl, hydroxy, methoxy, cyano, acetyl, —C( ⁇ O)NH 2 , trifuluoromethyloxy, methanesulfonyl, or 1-hydroxy-1-methyl-ethyl, or two adjacent L groups are joined together to form a methylenedioxy group.
  • Y 1 , Y 2 , Y 3 and Y 4 are selected from the group consisting of
  • Y 1 and Y 3 are C(L), Y 2 is CH and Y 4 is N;
  • Y 1 is CH, Y 2 and Y 3 are C(L) and Y 4 is N;
  • Y 1 , Y 2 and Y 3 are C(L) and Y 4 is N;
  • Y 1 and Y 3 are C(L), Y 2 is N and Y 4 is CH;
  • Y 1 and Y 2 are CH, Y 3 is C(L) and Y 4 is N;
  • Y 1 and Y 3 are CH, Y 2 is C(L) and Y 4 is N;
  • Y 1 and Y 2 are C(L), Y 3 is CH and Y 4 is N;
  • Y 1 and Y 2 are C(L), Y 3 is N and Y 4 is CH;
  • Y 1 is C(L), Y 2 and Y 3 are CH, and Y 4 is N;
  • Y 2 is C(L), Y 1 and Y 3 are CH, and Y 4 is N;
  • R 1 is methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, neopentyl, thiazolylethyl methylamino, dimethylamino, pyrrolidinyl, pyridyl, or 1-acetylamino-1-methylethyl;
  • A is phenyl
  • B is ethylene or propylene
  • W is NH, N—CH 3 or O
  • R 2 is H
  • Z is phenyl, pyrazolyl, thiazolyl, thiadiazolyl, thienyl, naphthyl or benzothienyl, said phenyl, pyrazolyl, thiazolyl, thiadiazolyl and thienyl being optionally substituted with one to three substituents independently selected from chloro, bromo, methyl, acetylamino, pivaloylamino, nitro and phenyl; and
  • L is chloro, methyl, trifuluoromethyl, hydroxy, methoxy, cyano, acetyl, —C( ⁇ O)NH 2 , trifuluoromethyloxy, methanesulfonyl, or 1-hydroxy-1-methyl-ethyl, or two adjacent L groups are joined together to form a methylenedioxy group.
  • an agent that inhibits EP4 activity is a compound of formula I, or a pharmaceutically acceptable salt thereof, wherein
  • Y 1 , Y 2 , Y 3 and Y 4 are selected from the group consisting of
  • Y 1 and Y 3 are C(L), Y 2 is CH and Y 4 is N;
  • Y 1 is CHY 2 and Y 3 are C(L) and Y 4 is N;
  • Y 1 , Y 2 and Y 3 are C(L) and Y 4 is N;
  • Y 1 and Y 3 are C(L), Y 2 is N and Y 4 is CH;
  • R 1 is methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, neopentyl, thiazolylethyl methylamino, dimethylamino, pyrrolidinyl, pyridyl, or 1-acetylamino-1-methylethyl;
  • A is phenyl
  • B is ethylene or propylene
  • W is NH, N—CH 3 or O
  • R 2 is H
  • Z is phenyl, pyrazolyl, thiazolyl, thiadiazolyl, thienyl, naphthyl or benzothienyl, said phenyl, pyrazolyl, thiazolyl, thiadiazolyl and thienyl being optionally substituted with one to three substituents independently selected from chloro, bromo, methyl, acetylamino, pivaloylamino, nitro and phenyl; and
  • L is chloro, methyl, trifuluoromethyl, hydroxy, methoxy, cyano, acetyl, —C( ⁇ O)NH 2 , trifuluoromethyloxy, methanesulfonyl, or 1-hydroxy-1-methyl-ethyl, or two adjacent L groups are joined together to form a methylenedioxy group.
  • an agent that inhibits EP4 activity is a compound of formula II:
  • R 1 is H, C 1-8 alkyl, C 2-8 alkenyl, C 2-8 alkynyl, C 3-7 cycloalkyl, C 1-8 alkoxy, halo-substituted C 1-8 alkoxy, C 1-8 alkyl-S(O)m-, Q 1 -, amino, mono- or di-(C 1-8 alkyl)amino, C 1-4 alkyl-C( ⁇ O)—N(R 3 )— or C 1-4 alkyl-S(O)m-N(R 3 )—, wherein said C 1-8 alkyl, C 2-8 alkenyl and C 2-8 alkynyl are optionally substituted with halo, C 1-3 alkyl, C 1-4 alkoxy-, C 1-4 alkyl-S(O)m-, C 3-7 cycloalkyl-, cyano, indanyl, 1,2,3,4-tetrahydronaphtyl, 1,2-dihydronapht
  • Q 1 is a 5-12 membered monocyclic or bicyclic aromatic ring optionally containing up to 4 heteroatoms selected from O, N and S, and is optionally substituted with halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, R 3 N(R 4 )C( ⁇ O)—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl
  • A is a benzene ring optionally substituted with up to 3 substituents or pyridine ring optionally substituted with up to 3 substituents, wherein said substituents selected from halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, acetyl, R 3 N(R 4 )C( ⁇ O)—, HO(O ⁇ )C—, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkylsulfonylamino, C 3-7 cycloalkyl, R 3 C(
  • B is C 2-6 alkylene, C 3-7 cycloalkylene, C 2-6 alkenylene, or C 2-6 alkynylene optionally substituted with C 1-3 alkyl;
  • W is NH or O
  • P is H, a protecting group, or Q 3 -OC( ⁇ O)—;
  • Q 3 is a 6-10 membered monocyclic or bicyclic aromatic ring optionally substituted with halo, C 1-4 alkyl, C 1-4 alkoxy, C 1-4 alkylthio, nitro, cyano, C 1-4 alkylsulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, or C 1-4 alkyl-O(O ⁇ )C—;
  • L is halo, C 1-4 alkyl, halo-substituted C 1-4 alkyl, hydroxy, C 1-4 alkoxy, halo-substituted C 1-4 alkoxy, C 1-4 alkylthio, nitro, amino, mono- or di-(C 1-4 alkyl)amino, cyano, HO—C 1-4 alkyl, C 1-4 alkoxy-C 1-4 alkyl, C 1-4 alkylsulfonyl, aminosulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C, C 1-4 alkyl-O(O ⁇ )C—, C 1-4 alkyl sulfonylamino, C 3-7 cycloalkyl, R 3 C( ⁇ O)N(R 4 )—, NH 2 (HN ⁇ )C—, R 3 N(R 4 )C( ⁇ O)— or R 3 N(R 4 )S(O)m-, or
  • n 0, 1 or 2;
  • P is H.
  • P is a protecting group.
  • protecting groups are described in detail in Greene (2006), the content of which is incorporated herein by reference in its entirety.
  • P is a suitable amino protecting group.
  • Suitable amino protecting groups are well known in the art and include those described in detail in Greene (2006).
  • suitable amino protecting groups, taken with the —NH-moiety to which they are attached include, but are not limited to, aralkylamines, carbamates, allyl amines, amides, and the like.
  • P is an amino protecting group selected from t-butyloxycarbonyl (BOC), ethyloxycarbonyl, methyloxycarbonyl, trichloroethyloxycarbonyl, allyloxycarbonyl (Alloc), benzyloxycarbonyl (CBZ), allyl, benzyl (Bn), fluorenylmethylcarbonyl (Fmoc), acetyl, chloroacetyl, dichloroacetyl, trichloroacetyl, phenylacetyl, trifluoroacetyl, benzoyl, or pivaloyl.
  • P is an amino protecting group selected from t-butyloxycarbonyl, ethyloxycarbonyl, pivaloyl, and acetyl. In some embodiments, P is pivaloyl.
  • P is a suitable hydroxyl protecting group.
  • Suitable hydroxyl protecting groups are well known in the art and include those described in detail in Greene (2006).
  • a suitable hydroxyl protecting group, taken with the oxygen atom to which it is bound is selected from esters, ethers, silyl ethers, alkyl ethers, arylalkyl ethers, and alkoxyalkyl ethers. Examples of such esters include formates, acetates, carbonates, and sulfonates.
  • Specific examples include formate, benzoyl formate, chloroacetate, trifluoroacetate, methoxyacetate, triphenylmethoxyacetate, p-chlorophenoxyacetate, 3-phenylpropionate, 4-oxopentanoate, 4,4-(ethylenedithio)pentanoate, pivaloate (trimethylacetyl), crotonate, 4-methoxy-crotonate, benzoate, p-benylbenzoate, 2,4,6-trimethylbenzoate, carbonates such as methyl, 9-fluorenylmethyl, ethyl, 2,2,2-trichloroethyl, 2-(trimethylsilyl)ethyl, 2-(phenylsulfonyl)ethyl, vinyl, allyl, and p-nitrobenzyl.
  • silyl ethers examples include trimethylsilyl, triethylsilyl, t-butyldimethylsilyl, t-butyldiphenylsilyl, triisopropylsilyl, and other trialkylsilyl ethers.
  • Alkyl ethers include methyl, benzyl, p-methoxybenzyl, 3,4-dimethoxybenzyl, trityl, t-butyl, allyl, and allyloxycarbonyl ethers or derivatives.
  • Alkoxyalkyl ethers include acetals such as methoxymethyl, methylthiomethyl, (2-methoxyethoxy)methyl, benzyloxymethyl, beta-(trimethylsilyl)ethoxymethyl, and tetrahydropyranyl ethers.
  • arylalkyl ethers include benzyl, p-methoxybenzyl (MPM), 3,4-dimethoxybenzyl, O-nitrobenzyl, p-nitrobenzyl, p-halobenzyl, 2,6-dichlorobenzyl, p-cyanobenzyl, 2- and 4-picolyl.
  • a suitable hydroxyl protecting group taken with the oxygen atom to which it is bound, is a silyl ether or arylalkyl ether.
  • P is a suitable hydroxyl protecting group selected from t-butyldimethylsilyl and benzoyl.
  • P is t-butyldimethylsilyl (“TBS”).
  • P is Q 3 -OC( ⁇ O)—, wherein Q 3 is as defined in the embodiments described herein.
  • Q 3 is a 6 membered monocyclic aromatic ring optionally substituted with halo, C 1-4 alkyl, C 1-4 alkoxy, C 1-4 alkylthio, nitro, cyano, C 1-4 alkylsulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, or C 1-4 alkyl-O(O ⁇ )C—.
  • Q 3 is a 8-10 membered bicyclic aromatic ring optionally substituted with halo, C 1-4 alkyl, C 1-4 alkoxy, C 1-4 alkylthio, nitro, cyano, C 1-4 alkylsulfonyl, C 1-4 alkylC( ⁇ O)—, HO(O ⁇ )C—, or C 1-4 alkyl-O(O ⁇ )C—.
  • an agent that inhibits EP4 activity is a compound of formula III,
  • P is H.
  • P is a protecting group
  • P is Z—S(O) 2 —N(R 2 )—C( ⁇ O)—, wherein Z is as defined in the embodiments described herein.
  • an agent that inhibits EP4 activity is a compound of formula (I′):
  • A′ represents a phenyl group or a pyridyl group
  • B′ represents an aryl group or a heteroaryl group
  • E′ represents a 1,4-phenylene group
  • R 1′ and R 2′ independently represent a hydrogen atom, a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group;
  • R 3′ and R 4′ independently represent a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms; or R 3′ and R 4′ groups may be joined together to form an alkylene chain having 2 to 6 carbon atoms;
  • R 5′ represents
  • R 6′ represents an alkyl group having from 1 to 6 carbon atoms, a cycloalkyl group having from 3 to 7 ring atoms, an aryl group or a heteroaryl group;
  • X′ represents a methylene group, an oxygen atom or a sulfur atom
  • said aryl groups have from 6 to 10 carbon atoms
  • heteroaryl groups are 5- to 10-membered aromatic heterocyclic groups containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms;
  • said aryl groups and said heteroaryl groups referred to in the definitions of B′ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said 1,4-phenylene group referred to in the definition of E′ is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said aryl groups and said heteroaryl groups referred to in the definitions of R 6′ and ⁇ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene or an alkenylene chain having 3 or 4 carbon atoms, aminocarbonyl groups, alkenyl groups having from 2 to 5 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms, aminosulfinyl groups, aminosulf
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms and cyano groups;
  • W′ is a pharmaceutically acceptable ester pro-drug group
  • R 1′ and R 2′ do not represent a hydrogen atom simultaneously.
  • A′ represents a phenyl group or a pyridyl group.
  • A′ is phenyl. In some embodiments, A′ is pyridyl.
  • A′ is selected from those as depicted in Table 2.
  • B′ represents an aryl group or a heteroaryl group.
  • B′ is aryl
  • B′ is heteroaryl
  • B′ represents a phenyl or pyridyl group, said group is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ , wherein each substituent ⁇ is as defined in the embodiments described herein.
  • B′ represents a phenyl group optionally substituted by substituent selected from the group consisting of substituents ⁇ , wherein each substituent ⁇ is as defined in the embodiments described herein.
  • R 1′ represents a hydrogen atom, a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group.
  • R 1′ is a hydrogen atom. In some embodiments, R 1′ is a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group.
  • R 2′ represents a hydrogen atom, a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group.
  • R 2′ is a hydrogen atom. In some embodiments, R 2′ is a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group.
  • R 2′ is a halogen atom. In some embodiments, R 2′ is an alkyl group having from 1 to 4 carbon atoms. In some embodiments, R 2′ is an alkoxy group having from 1 to 4 carbon atoms. In some embodiments, R 2′ is a haloalkyl group having from 1 to 4 carbon atoms. In some embodiments, R 2′ is a haloalkoxy group having from 1 to 4 carbon atoms. In some embodiments, R 2′ is a cyano group. In some embodiments, R 2′ is an aminocarbonyl group.
  • R 1′ represents a halogen atom and R 2′ represents a hydrogen atom.
  • each of R 1′ and R 2′ is independently selected from those as depicted in Table 2.
  • R 3′ and R 4′ independently represent a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms; or R 3′ and R 4′ groups may be joined together to form an alkylene chain having 2 to 6 carbon atoms.
  • R 3′ represents a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms.
  • R 3′ is a hydrogen atom. In some embodiments, R 3′ is an alkyl group having from 1 to 4 carbon atoms.
  • R 4′ represents a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms.
  • R 4′ is a hydrogen atom. In some embodiments, R 4′ is an alkyl group having from 1 to 4 carbon atoms.
  • R 3′ and R 4′ independently represent a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms.
  • R 3′ represents a methyl group and R 4′ represents a hydrogen atom.
  • each of R 3′ and R 4′ is independently selected from those as depicted in Table 2.
  • R 5′ represents —CO 2 H, —CO 2 W′,
  • R 5′ is —CO 2 H.
  • R 5′ is —CO 2 W′, wherein W′ is as defined in the embodiments described herein.
  • R 5′ is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl
  • R 5′ is N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl
  • R 6′ is as defined in the embodiments described herein.
  • R 5′ represents —CO 2 H
  • R 6′ represents an aryl group optionally substituted by halogen atoms or a heteroaryl group.
  • R 5′ represents —CO 2 H
  • R 6′ represents an aryl group optionally substituted by halogen atoms.
  • R 5′ represents —CO 2 H
  • R 6′ represents a phenyl group optionally substituted by halogen atoms.
  • R 5′ represents —CO 2 H or
  • R 5′ is selected from those as depicted in Table 2.
  • R 6′ represents an alkyl group having from 1 to 6 carbon atoms, a cycloalkyl group having from 3 to 7 ring atoms, an aryl group or a heteroaryl group.
  • R 6′ is an alkyl group having from 1 to 6 carbon atoms.
  • R 6′ is a cycloalkyl group having from 3 to 7 ring atoms.
  • R 6′ is an aryl group.
  • R 6′ is a heteroaryl group.
  • R 6′ is selected from those as depicted in Table 2.
  • X′ represents a methylene group, an oxygen atom or a sulfur atom.
  • X′ is a methylene group.
  • X is an oxygen atom.
  • X′ is a sulfur atom.
  • X′ represents a methylene group or an oxygen atom.
  • X′ is selected from those as depicted in Table 2.
  • said aryl groups have from 6 to 10 carbon atoms.
  • an aryl group has 6 carbon items. In some embodiments, an aryl group has 7 carbon items. In some embodiments, an aryl group has 8 carbon items. In some embodiments, an aryl group has 9 carbon items. In some embodiments, an aryl group has 10 carbon items.
  • an aryl group is selected from those as depicted in Table 2.
  • said heteroaryl groups are 5- to 10-membered aromatic heterocyclic groups containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is a 5-membered aromatic heterocyclic group containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is a 6-membered aromatic heterocyclic group containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is a 7-membered aromatic heterocyclic group containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is a 8-membered aromatic heterocyclic group containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is a 9-membered aromatic heterocyclic group containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is a 10-membered aromatic heterocyclic group containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms.
  • a heteroaryl group is selected from those as depicted in Table 2.
  • said aryl groups and said heteroaryl groups referred to in the definitions of B′ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • an aryl group referred to in the definitions of B′ is unsubstituted. In some embodiments, an aryl group referred to in the definitions of B′ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • a heteroaryl group referred to in the definitions of B′ is unsubstituted. In some embodiments, a heteroaryl group referred to in the definitions of B′ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • said aryl groups and said heteroaryl groups referred to in the definitions of B′ are selected from those as depicted in Table 2.
  • said 1,4-phenylene group referred to in the definition of E′ is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • a 1,4-phenylene group referred to in the definition of E′ is unsubstituted. In some embodiments, a 1,4-phenylene group referred to in the definition of E′ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • a 1,4-phenylene group referred to in the definition of E′ is a 1,4-phenylene group substituted by at least one substituent selected from the group consisting of halogen atoms and alkyl groups having from 1 to 4 carbon atoms.
  • said 1,4-phenylene group referred to in the definition of E′ is selected from those as depicted in Table 2.
  • said aryl groups and said heteroaryl groups referred to in the definitions of R 6′ and ⁇ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • an aryl group referred to in the definitions of R 6′ is unsubstituted. In some embodiments, an aryl group referred to in the definitions of R 6′ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • an aryl group referred to in the definitions of ⁇ is unsubstituted. In some embodiments, an aryl group referred to in the definitions of ⁇ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • a heteroaryl group referred to in the definitions of R 6′ is unsubstituted. In some embodiments, a heteroaryl group referred to in the definitions of R 6′ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • a heteroaryl group referred to in the definitions of ⁇ is unsubstituted. In some embodiments, a heteroaryl group referred to in the definitions of ⁇ is substituted by at least one substituent selected from the group consisting of substituents ⁇ .
  • each of said aryl groups and said heteroaryl groups referred to in the definitions of R 6′ and a is independently selected from those as depicted in Table 2.
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene or an alkenylene chain having 3 or 4 carbon atoms, aminocarbonyl groups, alkenyl groups having from 2 to 5 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms, aminosulfinyl groups,
  • a substituent ⁇ is selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, aminocarbonyl groups, alkenyl groups having from 2 to 5 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms, aminosulfinyl groups, aminosulfonyl groups, hydroxy groups, hydroxyalkyl groups having from 1 to 4 carbon atoms, nitro groups
  • a substituent ⁇ is a halogen atom.
  • a substituent ⁇ is an alkyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is an alkoxy group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a haloalkyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a haloalkoxy group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a cyano group.
  • a substituent ⁇ is an alkynyl group having from 2 to 6 carbon atoms.
  • a substituent ⁇ is an alkanoyl group having from 1 to 5 carbon atoms.
  • a substituent ⁇ is a cycloalkyl group having from 3 to 7 ring atoms.
  • a substituent ⁇ is a heteroaryl group.
  • a substituent ⁇ is an aryl group.
  • a substituent ⁇ is an aralkoxy group having from 7 to 10 carbon atoms.
  • a substituent ⁇ is an arylcarbonyl group.
  • a substituent ⁇ is an aminocarbonyl group.
  • a substituent ⁇ is an alkenyl group having from 2 to 5 carbon atoms.
  • a substituent ⁇ is an alkylthio group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is an aminosulfinyl group.
  • a substituent ⁇ is an aminosulfonyl group.
  • a substituent ⁇ is a hydroxy group.
  • a substituent ⁇ is a hydroxyalkyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a nitro group.
  • a substituent ⁇ is an amino group.
  • a substituent ⁇ is a carboxy group.
  • a substituent ⁇ is an alkoxycarbonyl group having from 2 to 5 carbon atom.
  • a substituent ⁇ is an alkoxyalkyl group having from 1 to 4 carbon atom.
  • a substituent ⁇ is an alkylsulfonyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is an alkanoylamino group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is an alkanoyl(alkyl)amino group having from 1 to 6 carbon atoms.
  • a substituent ⁇ is an alkanoylaminoalkyl group having from 1 to 6 carbon atoms in both the alkanoyl and alkyl part.
  • a substituent ⁇ is an alkanoyl(alkyl)aminoalkyl group having from 1 to 6 carbon atoms in both the alkanoyl and each alkyl part.
  • a substituent ⁇ is an alkylsulfonylamino group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a mono- or di-alkylaminocarbonyl group having from 1 to 6 carbon atoms.
  • a substituent ⁇ is a mono- or di-alkylaminosulfinyl group having from 1 to 6 carbon atom.
  • a substituent ⁇ is a mono- or di-alkylaminosulfonyl group having from 1 to 6 carbon atom.
  • a substituent ⁇ is an aminoalkyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a mono- or di-alkylamino group having from 1 to 6 carbon atoms.
  • a substituent ⁇ is a mono- or di-alkylaminoalkyl group having from 1 to 6 carbon atoms in each alkyl part.
  • a substituent ⁇ is an aralkyl group having from 7 to 10 carbon atoms.
  • a substituent ⁇ is a heteroarylalkyl group having from 1 to 4 carbon atoms in the alkyl part.
  • a substituent ⁇ is a heteroarylalkoxy group having from 1 to 4 carbon atoms in the alkoxy part.
  • a substituent ⁇ is an alkylsulfonylamino group having from 1 to 4 carbon atoms.
  • two adjacent a groups are optionally joined together to form an alkylene or an alkenylene chain having 3 or 4 carbon atoms.
  • two adjacent a groups are optionally joined together to form an alkylene chain having 3 or 4 carbon atoms. In some embodiments, two adjacent a groups are optionally joined together to form an alkenylene chain having 3 or 4 carbon atoms.
  • said substituents ⁇ are selected from the group consisting halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene chain having 3 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms, and di-alkylaminoalkyl groups having from 1 to 6 carbon atoms in the alkyl part, said heteroaryl groups referred to in the definitions of a are unsubstituted or are substituted by alkyl part,
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 4 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, alkylthio groups having from 1 to 4 carbon atoms, di-alkylaminoalkyl groups having from 1 to 6 carbon atoms in the alkyl part, thiazolyl groups, isothiazolyl groups, oxazolyl groups, isoxazolyl groups, imidazolyl groups, pyridyl groups, benzyloxy groups, phenyl groups or benzoyl groups; said thiazolyl groups, isothiazolyl groups, oxazolyl groups,
  • said substituents ⁇ are selected from the group consisting of fluorine atoms, chlorine atoms, methyl groups, ethyl groups, methoxy groups, trifluoromethoxy groups, cyano groups, ethynyl groups, acetyl groups, cyclopentyl groups, methylthio groups, dimethylaminoethyl groups, phenyl groups, imidazolyl groups optionally substituted by methyl groups, thiazolyl groups optionally substituted by methyl groups, pyridyl groups or benzyloxy groups.
  • said substituents ⁇ are selected from those depicted in Table 2.
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms and cyano groups.
  • a substituent ⁇ is a halogen atoms.
  • a substituent ⁇ is an alkyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is an alkoxy group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a haloalkyl group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a haloalkoxy group having from 1 to 4 carbon atoms.
  • a substituent ⁇ is a cyano group.
  • said substituents ⁇ are selected from those as depicted in Table 2.
  • W′ is a pharmaceutically acceptable ester pro-drug group.
  • W′ is selected from those as depicted in Table 2.
  • a compound of formula I′ is a compound depicted in Table 2, or a pharmaceutically acceptable salt thereof.
  • a compound of formula I′ is a compound selected from the group consisting of I′-1 to I′-7, I′-8, I′-11 to I′-13, I′-15, I′-16, I′-18, I′-20, I′-22, I′-23, I′-25, I′-26, I′-28, I′-29, I′-34 to I′-38, I′-40 to I′-43, or a pharmaceutically acceptable salt thereof.
  • an agent that inhibits EP4 activity is a compound of formula I′, or a pharmaceutically acceptable salt thereof, wherein:
  • A′ represents a phenyl group or a pyridyl group
  • B′ represents an aryl group or a heteroaryl group
  • E′ represents a 1,4-phenylene group
  • R 1′ and R 2′ independently represent a hydrogen atom, a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group;
  • R 3′ and R 4′ independently represent a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms; or R 3′ and R 4′ groups may be joined together to form an alkylene chain having 2 to 6 carbon atoms;
  • R 5′ represents —CO 2 H, —CO 2 W′,
  • R 6′ represents an alkyl group having from 1 to 6 carbon atoms, a cycloalkyl group having from 3 to 7 ring atoms, an aryl group or a heteroaryl group;
  • X′ represents a methylene group, an oxygen atom or a sulfur atom
  • said aryl groups have from 6 to 10 carbon atoms
  • heteroaryl groups are 5- to 10-membered aromatic heterocyclic groups containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms; said aryl groups and said heteroaryl groups referred to in the definitions of B′ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said 1,4-phenylene group referred to in the definition of E′ is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said aryl groups and said heteroaryl groups referred to in the definitions of R 6′ and ⁇ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene or an alkenylene chain having 3 or 4 carbon atoms, aminocarbonyl groups, alkenyl groups having from 2 to 5 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms aminosulfinyl groups, aminosulfony
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms and cyano groups;
  • W′ is a pharmaceutically acceptable ester pro-drug group
  • R 1′ and R 2′ do not represent a hydrogen atom simultaneously.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein E′ represents an unsubstituted 1,4-phenylene group.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein E′ represents a 1,4-phenylene group substituted by at least one substituent selected from the group consisting of halogen atoms and alkyl groups having from 1 to 4 carbon atoms.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein B′ represents a phenyl or pyridyl group; said group is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ ; said substituents ⁇ are selected from the group consisting halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene chain
  • an agent that inhibits EP4 activity is a compound of formula I′, or a pharmaceutically acceptable salt thereof, wherein B′ represents a phenyl group optionally substituted by substituent selected from the group consisting of substituents ⁇ ; said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 4 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, alkylthio groups having from 1 to 4 carbon atoms, di-alkylaminoalkyl groups having from 1 to 6 carbon atoms in the alkyl part, thiazolyl groups, isothiazolyl groups, oxazolyl groups, isoxazolyl groups, is
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein B′ represents a phenyl group optionally substituted by substituent selected from the group consisting of substituents ⁇ ; said substituents ⁇ are selected from the group consisting of fluorine atoms, chlorine atoms, methyl groups, ethyl groups, methoxy groups, trifluoromethoxy groups, cyano groups, ethynyl groups, acetyl groups, cyclopentyl groups, methylthio groups, dimethylaminoethyl groups, phenyl groups, imidazolyl groups optionally substituted by methyl groups, thiazolyl groups optionally substituted by methyl groups, pyridyl groups or benzyloxy groups.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein X′ represents a methylene group or an oxygen atom.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 1′ represents a halogen atom and R 2′ represents a hydrogen atom.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 3′ and R 4′ independently represent a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein:
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 3′ represents an alkyl group having from 1 to 4 carbon atoms and R 4′ represents a hydrogen atom.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 3′ represents a methyl group and R 4′ represents a hydrogen atom.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 5′ represents —CO 2 H,
  • R 6′ represents an aryl group optionally substituted by halogen atoms or an heteroaryl group.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 5′ represents —CO 2 H,
  • R 6′ represents an aryl group optionally substituted by halogen atoms.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 5′ represents —CO 2 H,
  • R 6′ represents a phenyl group optionally substituted by halogen atoms.
  • an agent that inhibits EP4 activity is a compound of formula (I′), or a pharmaceutically acceptable salt thereof, wherein R 5′ represents —CO 2 H, or
  • an agent that inhibits EP4 activity is a compound of formula (II′):
  • A′ represents a phenyl group or a pyridyl group
  • B′ represents an aryl group or a heteroaryl group
  • E′ represents a 1,4-phenylene group
  • R 1′ and R 2′ independently represent a hydrogen atom, a halogen atom, an alkyl group having from 1 to 4 carbon atoms, an alkoxy group having from 1 to 4 carbon atoms, a haloalkyl group having from 1 to 4 carbon atoms, a haloalkoxy group having from 1 to 4 carbon atoms, a cyano group or an aminocarbonyl group;
  • R 3′ and R 4′ independently represent a hydrogen atom or an alkyl group having from 1 to 4 carbon atoms; or R 3′ and R 4′ groups may be joined together to form an alkylene chain having 2 to 6 carbon atoms;
  • R a′ represents an alkyl groups having from 1 to 6 carbon atoms or an aralkyl group having from 7 to 12 carbon atoms;
  • X′ represents a methylene group, an oxygen atom or a sulfur atom
  • said aryl groups have from 6 to 10 carbon atoms
  • heteroaryl groups are 5- to 10-membered aromatic heterocyclic groups containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms;
  • said aryl groups and said heteroaryl groups referred to in the definitions of B′ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said 1,4-phenylene group referred to in the definition of E′ is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said aryl groups and said heteroaryl groups referred to in the definitions of R 6′ and ⁇ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene or an alkenylene chain having 3 or 4 carbon atoms, aminocarbonyl groups, alkenyl groups having from 2 to 5 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms, aminosulfinyl groups, aminosulf
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms and cyano groups;
  • R 1′ and R 2′ do not represent a hydrogen atom simultaneously.
  • R a′ represents an alkyl groups having from 1 to 6 carbon atoms or an aralkyl group having from 7 to 12 carbon atoms.
  • R a′ represents an alkyl groups having from 1 to 6 carbon atoms. In some embodiments, R a represents an alkyl groups having from 1 to 5 carbon atoms. In some embodiments, R a represents an alkyl groups having from 1 to 4 carbon atoms. In some embodiments, R a′ represents an alkyl groups having from 1 to 3 carbon atoms. In some embodiments, R a′ is methyl. In some embodiments, R a′ is ethyl. In some embodiments, R a′ is propyl or isopropyl.
  • R a′ represents an aralkyl group having from 7 to 12 carbon atoms. In some embodiments, R a′ represents an aralkyl group having from 7 to 11 carbon atoms. In some embodiments, R a′ represents an aralkyl group having from 7 to 10 carbon atoms. In some embodiments, R a′ represents an aralkyl group having from 7 to 9 carbon atoms. In some embodiments, R a′ represents an aralkyl group having from 8 to 10 carbon atoms.
  • R a′ is selected from those as depicted in Table 2.
  • an agent that inhibits EP4 activity is a compound of the formula (III′):
  • said 1,4-phenylene group referred to in the definition of E′ is unsubstituted or is substituted by at least one substituent selected from the group consisting of substituents ⁇ ; said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms and cyano groups;
  • the agent that inhibits EP4 activity is a compound of the formula (I′):
  • said aryl groups have from 6 to 10 carbon atoms
  • heteroaryl groups are 5- to 10-membered aromatic heterocyclic groups containing from 1 to 3 heteroatoms selected from the group consisting of sulfur atoms, oxygen atoms and nitrogen atoms;
  • said aryl groups and said heteroaryl groups referred to in the definitions of B′ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents;
  • phenylene groups referred to in the definitions of E′ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said aryl groups and said heteroaryl groups referred to in the definitions of R 6′ and ⁇ are unsubstituted or are substituted by at least one substituent selected from the group consisting of substituents ⁇ ;
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms, haloalkoxy groups having from 1 to 4 carbon atoms, cyano groups, alkynyl groups having from 2 to 6 carbon atoms, alkanoyl groups having from 1 to 5 carbon atoms, cycloalkyl groups having from 3 to 7 ring atoms, heteroaryl groups, aryl groups, aralkoxy groups having from 7 to 10 carbon atoms, arylcarbonyl groups, two adjacent a groups are optionally joined together to form an alkylene or an alkenylene chain having 3 or 4 carbon atoms, aminocarbonyl groups, alkenyl groups having from 2 to 5 carbon atoms, alkylthio groups having from 1 to 4 carbon atoms, aminosulfinyl groups, aminosulf
  • said substituents ⁇ are selected from the group consisting of halogen atoms, alkyl groups having from 1 to 4 carbon atoms, alkoxy groups having from 1 to 4 carbon atoms, haloalkyl groups having from 1 to 4 carbon atoms or haloalkoxy groups having from 1 to 4 carbon atoms or cyano groups.
  • E′ represents an unsubstituted 1,4-phenylene group.
  • an immuno-oncology agent can be administered with an agent that inhibits EP4 activity for treatment of a proliferative disorder as described herein.
  • an immuno-oncology agent refers to an agent which is effective to enhance, stimulate, and/or up-regulate immune responses in a subject.
  • the administration of an immuno-oncology agent with an agent that inhibits EP4 activity has a synergic effect in treating cancer.
  • an agent that inhibits EP4 activity is compound A, or a pharmaceutically acceptable salt thereof.
  • an agent that inhibits EP4 activity is compound B, or a pharmaceutically acceptable salt thereof.
  • an agent that inhibits EP4 activity is sequentially administered prior to administration of an immuno-oncology agent. In some embodiments, an agent that inhibits EP4 activity is administered concurrently with an immuno-oncology agent. In some embodiments, an agent that inhibits EP4 activity is sequentially administered after administration of an immuno-oncology agent.
  • an immuno-oncology agent is (i) an agonist of a stimulatory (including a co-stimulatory) receptor or (ii) an antagonist of an inhibitory (including a co-inhibitory) signal on T cells, both of which result in amplifying antigen-specific T cell responses.
  • Certain of the stimulatory and inhibitory molecules are members of the immunoglobulin super family (IgSF).
  • IgSF immunoglobulin super family
  • B7 family which includes B7-1, B7-2, B7-H1 (PD-L1), B7-DC (PD-L2), B7-H2 (ICOS-L), B7-H3, B7-H4, B7-H5 (VISTA), and B7-H6.
  • TNF family of molecules that bind to cognate TNF receptor family members which includes CD40 and CD40L, OX-40, OX-40L, CD70, CD27L, CD30, CD30L, 4-1BBL, CD137 (4-1BB), TRAIL/Apo2-L, TRAILR1/DR4, TRAILR2/DR5, TRAILR3, TRAILR4, OPG, RANK, RANKL, TWEAKR/Fn14, TWEAK, BAFFR, EDAR, XEDAR, TACI, APRIL, BCMA, LT ⁇ R, LIGHT, DcR3, HVEM, VEGI/TL1A, TRAMP/DR3, EDAR, EDA1, XEDAR, EDA2, TNFR1, Lymphotoxin ⁇ /TNF ⁇ , TNFR2, TNF ⁇ , LT ⁇ R, Lymphotoxin ⁇ 1 ⁇ 2, FA
  • an immuno-oncology agent is a cytokine that inhibits T cell activation (e.g., IL-6, IL-10, TGF- ⁇ , VEGF, and other immunosuppressive cytokines) or a cytokine that stimulates T cell activation, for stimulating an immune response.
  • a cytokine that inhibits T cell activation e.g., IL-6, IL-10, TGF- ⁇ , VEGF, and other immunosuppressive cytokines
  • a cytokine that stimulates T cell activation for stimulating an immune response.
  • an immuno-oncology agent is: (i) an antagonist of a protein that inhibits T cell activation (e.g., immune checkpoint inhibitors) such as CTLA-4, PD-1, PD-L1, PD-L2, LAG-3, TIM-3, Galectin 9, CEACAM-1, BTLA, CD69, Galectin-1, TIGIT, CD113, GPR56, VISTA, 2B4, CD48, GARP, PD1H, LAIR1, TIM-1, and TIM-4; or (ii) an agonist of a protein that stimulates T cell activation such as B7-1, B7-2, CD28, 4-1BB (CD137), 4-1BBL, ICOS, ICOS-L, OX40, OX40L, GITR, GITRL, CD70, CD27, CD40, DR3 and CD28H.
  • an antagonist of a protein that inhibits T cell activation e.g., immune checkpoint inhibitors
  • CTLA-4 e.g., immune check
  • an immuno-oncology agent is an antagonist of inhibitory receptors on NK cells or an agonists of activating receptors on NK cells. In some embodiments, an immuno-oncology agent is an antagonists of KIR, such as lirilumab.
  • an immuno-oncology agent is a LAG-3 antagonist.
  • a LAG-3 antagonist is an antagonistic LAG-3 antibody.
  • a LAG3 antibody is BMS-986016 (WO10/19570, WO14/08218), or IMP-731 or IMP-321 (WO08/132601, WO009/44273).
  • an immuno-oncology agent is a CD137 (4-1BB) agonist.
  • a CD137 (4-1BB) agonist is an agonistic CD137 antibody.
  • a CD137 antibody is urelumab or PF-05082566 (WO12/32433).
  • an immuno-oncology agent is an IDO antagonist.
  • an IDO antagonist is INCB-024360 (WO2006/122150, WO07/75598, WO08/36653, WO08/36642), indoximod, or NLG-919 (WO09/73620, WO009/1156652, WO11/56652, WO12/142237).
  • an immuno-oncology agent is an OX40L antagonist.
  • an OX40L antagonist is an antagonistic OX40 antibody.
  • an OX40L antagonist is RG-7888 (WO006/029879).
  • an immuno-oncology agent is a CD40 agonist.
  • a CD40 agonist is an agonistic CD40 antibody.
  • an immuno-oncology agent is a CD40 antagonist.
  • a CD40 antagonist is an antagonistic CD40 antibody.
  • a CD40 antibody is lucatumumab or dacetuzumab.
  • an immuno-oncology agent is a CD27 agonist.
  • a CD27 agonist is an agonistic CD27 antibody.
  • a CD27 antibody is varlilumab.
  • an immuno-oncology agent is MGA271 (to B7H3) (WO11/109400).
  • the immunomodulatory therapeutic specifically induces apoptosis of tumor cells.
  • Approved immunomodulatory therapeutics which may be used in the present invention include pomalidomide (Pomalyst®, Celgene); lenalidomide (Revlimid®, Celgene); ingenol mebutate (Picato®, LEO Pharma).
  • an immuno-oncology agent is selected from an oncolytic viral therapy such as pexastimogene devacirepvec (PexaVec/JX-594, SillaJen/formerly Jennerex Biotherapeutics), a thymidine kinase- (TK-) deficient vaccinia virus engineered to express GM-CSF, for hepatocellular carcinoma (NCT02562755) and melanoma (NCT00429312); pelareorep (Reolysin®, Oncolytics Biotech), a variant of respiratory enteric orphan virus (reovirus) which does not replicate in cells that are not RAS-activated, in numerous cancers, including colorectal cancer (NCT01622543); prostate cancer (NCT01619813); head and neck squamous cell cancer (NCT01166542); pancreatic adenocarcinoma (NCT00998322); and non-small cell lung cancer (NSCLC) (
  • an immuno-oncology agent is selected from JX-929 (SillaJen/formerly Jennerex Biotherapeutics), a TK- and vaccinia growth factor-deficient vaccinia virus engineered to express cytosine deaminase, which is able to convert the prodrug 5-fluorocytosine to the cytotoxic drug 5-fluorouracil; TG01 and TG02 (Targovax/formerly Oncos), peptide-based immunotherapy agents targeted for difficult-to-treat RAS mutations; and TILT-123 (TILT Biotherapeutics), an engineered adenovirus designated:Ad5/3-E2F-delta24-hTNF ⁇ -IRES-hIL20; and VSV-GP (ViraTherapeutics) a vesicular stomatitis virus (VSV) engineered to express the glycoprotein (GP) of lymphocytic choriomeningitis virus (LCMV), which can be further engineered to
  • an immuno-oncology agent is a T-cell engineered to express a chimeric antigen receptor, or CAR.
  • the T-cells engineered to express such chimeric antigen receptor are referred to as a CAR-T cells.
  • the CAR-T cell is one of those described in U.S. Pat. No. 8,906,682 (June; hereby incorporated by reference in its entirety), which discloses CAR-T cells engineered to comprise an extracellular domain having an antigen binding domain (such as a domain that binds to CD19), fused to an intracellular signaling domain of the T cell antigen receptor complex zeta chain (such as CD3 zeta).
  • an antigen binding domain such as a domain that binds to CD19
  • CD3 zeta intracellular signaling domain of the T cell antigen receptor complex zeta chain
  • the CAR When expressed in the T cell, the CAR is able to redirect antigen recognition based on the antigen binding specificity.
  • CD19 the antigen is expressed on malignant B cells.
  • an immunostimulatory agent is selected from elotuzumab, mifamurtide, an agonist or activator of a toll-like receptor, and an activator of ROR ⁇ t.
  • an immunostimulatory therapeutic is recombinant human interleukin 15 (rhIL-15).
  • rhIL-15 has been tested in the clinic as a therapy for melanoma and renal cell carcinoma (NCT01021059 and NCT01369888) and leukemias (NCT02689453).
  • an immunostimulatory agent is recombinant human interleukin 12 (rhIL-12).
  • an IL-15 based immunotherapeutic is heterodimeric IL-15 (hetIL-15, Novartis/Admune), a fusion complex composed of a synthetic form of endogenous IL-15 complexed to the soluble IL-15 binding protein IL-15 receptor alpha chain (IL15:sIL-15RA), which has been tested in Phase 1 clinical trials for melanoma, renal cell carcinoma, non-small cell lung cancer and head and neck squamous cell carcinoma (NCT02452268).
  • a recombinant human interleukin 12 (rhIL-12) is NM-IL-12 (Neumedicines, Inc.), NCT02544724, or NCT02542124.
  • an immuno-oncology agent is an antibody which blocks the PD-L1/PD1 axis and/or CTLA4.
  • an immuno-oncology agent is an ex-vivo expanded tumor-infiltrating T cell.
  • an immuno-oncology agent is a bispecific antibody construct or chimeric antigen receptors (CARs) that directly connect T cells with tumor-associated surface antigens (TAAs).
  • an immuno-oncology agent is an immune checkpoint inhibitor as described herein.
  • B7 family ligands include, but are not limited to, B7-1, B7-2, B7-DC, B7-H1, B7-H2, B7-H3, B7-H4, B7-H5, B7-H6 and B7-H7.
  • Checkpoint inhibitors include antibodies, or antigen binding fragments thereof, other binding proteins, biologic therapeutics, or small molecules, that bind to and block or inhibit the activity of one or more of CTLA-4, PDL1, PDL2, PD1, BTLA, HVEM, TIM3, GAL9, LAG3, VISTA, KIR, 2B4, CD 160 and CGEN-15049.
  • Illustrative immune checkpoint inhibitors include Tremelimumab (CTLA-4 blocking antibody), anti-OX40, PD-L1 monoclonal Antibody (Anti-B7-H1; MEDI4736), MK-3475 (PD-1 blocker), Nivolumab (anti-PD1 antibody), CT-011 (anti-PD1 antibody), BY55 monoclonal antibody, AMP224 (anti-PDL1 antibody), BMS-936559 (anti-PDL1 antibody), MPLDL3280A (anti-PDL1 antibody), MSB0010718C (anti-PDL1 antibody), and ipilimumab (anti-CTLA-4 checkpoint inhibitor).
  • Checkpoint protein ligands include, but are not limited to PD-L1, PD-L2, B7-H3, B7-H4, CD28, CD86 and TIM-3.
  • the checkpoint inhibitor is selected from nivolumab (anti-PD-1 antibody, Opdivo®, Bristol-Myers Squibb); pembrolizumab (anti-PD-1 antibody, Keytruda®, Merck); ipilimumab (anti-CTLA-4 antibody, Yervoy®, Bristol-Myers Squibb); durvalumab (anti-PD-L1 antibody, Imfinzi®, AstraZeneca); and atezolizumab (anti-PD-L1 antibody, Tecentriq®, Genentech).
  • Tremelimumab (CP-675,206; Astrazeneca) is a fully human monoclonal antibody against CTLA-4 that has been in studied in clinical trials for a number of indications, including: mesothelioma, colorectal cancer, kidney cancer, breast cancer, lung cancer and non-small cell lung cancer, pancreatic ductal adenocarcinoma, pancreatic cancer, germ cell cancer, squamous cell cancer of the head and neck, hepatocellular carcinoma, prostate cancer, endometrial cancer, metastatic cancer in the liver, liver cancer, large B-cell lymphoma, ovarian cancer, cervical cancer, metastatic anaplastic thyroid cancer, urothelial cancer, fallopian tube cancer, multiple myeloma, bladder cancer, soft tissue sarcoma, and melanoma.
  • AGEN-1884 (Agenus) is an anti-CTLA4 antibody that is being studied in Phase 1 clinical trials for advanced solid tumors (NCT02694822).
  • a checkpoint inhibitor is an inhibitor of T-cell immunoglobulin mucin containing protein-3 (TIM-3).
  • TIM-3 inhibitors that may be used in the present invention include TSR-022, LY3321367 and MBG453.
  • TSR-022 (Tesaro) is an anti-TIM-3 antibody which is being studied in solid tumors (NCT02817633).
  • LY3321367 (Eli Lilly) is an anti-TIM-3 antibody which is being studied in solid tumors (NCT03099109).
  • MBG453 Novartis
  • a checkpoint inhibitor is an inhibitor of Lymphocyte Activation Gene-3 (LAG-3).
  • LAG-3 inhibitors that may be used in the present invention include BMS-986016 and REGN3767 and IMP321.
  • BMS-986016 (Bristol-Myers Squibb), an anti-LAG-3 antibody, is being studied in glioblastoma and gliosarcoma (NCT02658981).
  • REGN3767 (Regeneron), is also an anti-LAG-3 antibody, and is being studied in malignancies (NCT03005782).
  • IMP321 is an LAG-3-Ig fusion protein, being studied in melanoma (NCT02676869); adenocarcinoma (NCT02614833); and metastatic breast cancer (NCT00349934).
  • OX40 agonists that are being studied in clinical trials include PF-04518600/PF-8600 (Pfizer), an agonistic anti-OX40 antibody, in metastatic kidney cancer (NCT03092856) and advanced cancers and neoplasms (NCT02554812; NCT05082566); GSK3174998 (Merck), an agonistic anti-OX40 antibody, in Phase 1 cancer trials (NCT02528357); MEDI0562 (Medimmune/AstraZeneca), an agonistic anti-OX40 antibody, in advanced solid tumors (NCT02318394 and NCT02705482); MEDI6469, an agonistic anti-OX40 antibody (Medimmune/AstraZeneca), in patients with colorectal cancer (NCT02559024), breast cancer (NCT01862900), head and neck cancer (NCT02274155) and metastatic prostate cancer (
  • Checkpoint inhibitors that may be used in the present invention include CD137 (also called 4-1BB) agonists.
  • CD137 agonists that are being studied in clinical trials include utomilumab (PF-05082566, Pfizer) an agonistic anti-CD137 antibody, in diffuse large B-cell lymphoma (NCT02951156) and in advanced cancers and neoplasms (NCT02554812 and NCT05082566); urelumab (BMS-663513, Bristol-Myers Squibb), an agonistic anti-CD137 antibody, in melanoma and skin cancer (NCT02652455) and glioblastoma and gliosarcoma (NCT02658981).
  • Checkpoint inhibitors that may be used in the present invention include glucocorticoid-induced tumor necrosis factor receptor (GITR) agonists.
  • GITR agonists that are being studied in clinical trials include TRX518 (Leap Therapeutics), an agonistic anti-GITR antibody, in malignant melanoma and other malignant solid tumors (NCT01239134 and NCT02628574); GWN323 (Novartis), an agonistic anti-GITR antibody, in solid tumors and lymphoma (NCT 02740270); INCAGN01876 (Incyte/Agenus), an agonistic anti-GITR antibody, in advanced cancers (NCT02697591 and NCT03126110); MK-4166 (Merck), an agonistic anti-GITR antibody, in solid tumors (NCT02132754) and MED11873 (Medimmune/AstraZeneca), an agonistic hexameric GITR-ligand molecule with a human I
  • Checkpoint inhibitors that may be used in the present invention include inducible T-cell co-stimulator (ICOS, also known as CD278) agonists.
  • ICOS agonists that are being studied in clinical trials include MEDI-570 (Medimmune), an agonistic anti-ICOS antibody, in lymphomas (NCT02520791); GSK3359609 (Merck), an agonistic anti-ICOS antibody, in Phase 1 (NCT02723955); JTX-2011 (Jounce Therapeutics), an agonistic anti-ICOS antibody, in Phase 1 (NCT02904226).
  • KIR inhibitors that may be used in the present invention include killer IgG-like receptor (KIR) inhibitors.
  • KIR inhibitors that are being studied in clinical trials include lirilumab (IPH2102/BMS-986015, Innate Pharma/Bristol-Myers Squibb), an anti-KIR antibody, in leukemias (NCT01687387, NCT02399917, NCT02481297, NCT02599649), multiple myeloma (NCT02252263), and lymphoma (NCT01592370); IPH2101 (1-7F9, Innate Pharma) in myeloma (NCT01222286 and NCT01217203); and IPH4102 (Innate Pharma), an anti-KIR antibody that binds to three domains of the long cytoplasmic tail (KIR3DL2), in lymphoma (NCT02593045).
  • KIR3DL2 killer IgG-like receptor
  • Checkpoint inhibitors that may be used in the present invention include CD47 inhibitors of interaction between CD47 and signal regulatory protein alpha (SIRPa).
  • CD47/SIRPa inhibitors that are being studied in clinical trials include ALX-148 (Alexo Therapeutics), an antagonistic variant of (SIRPa) that binds to CD47 and prevents CD47/SIRPa-mediated signaling, in phase 1 (NCT03013218); TTI-621 (SIRPa-Fc, Trillium Therapeutics), a soluble recombinant fusion protein created by linking the N-terminal CD47-binding domain of SIRPa with the Fc domain of human IgG1, acts by binding human CD47, and preventing it from delivering its “do not eat” signal to macrophages, is in clinical trials in Phase 1 (NCT02890368 and NCT02663518); CC-90002 (Celgene), an anti-CD47 antibody, in leukemias (NCT02641002); and Hu5F
  • Checkpoint inhibitors that may be used in the present invention include CD73 inhibitors.
  • CD73 inhibitors that are being studied in clinical trials include MEDI9447 (Medimmune), an anti-CD73 antibody, in solid tumors (NCT02503774); and BMS-986179 (Bristol-Myers Squibb), an anti-CD73 antibody, in solid tumors (NCT02754141).
  • Checkpoint inhibitors that may be used in the present invention include agonists of stimulator of interferon genes protein (STING, also known as transmembrane protein 173, or TMEM173).
  • STING stimulator of interferon genes protein
  • Agonists of STING that are being studied in clinical trials include MK-1454 (Merck), an agonistic synthetic cyclic dinucleotide, in lymphoma (NCT03010176); and ADU-S100 (MIW815, Aduro Biotech/Novartis), an agonistic synthetic cyclic dinucleotide, in Phase 1 (NCT02675439 and NCT03172936).
  • Checkpoint inhibitors that may be used in the present invention include CSF1R inhibitors.
  • CSF1R inhibitors that are being studied in clinical trials include pexidartinib (PLX3397, Plexxikon), a CSF1R small molecule inhibitor, in colorectal cancer, pancreatic cancer, metastatic and advanced cancers (NCT02777710) and melanoma, non-small cell lung cancer, squamous cell head and neck cancer, gastrointestinal stromal tumor (GIST) and ovarian cancer (NCT02452424); and IMC-CS4 (LY3022855, Lilly), an anti-CSF-1R antibody, in pancreatic cancer (NCT03153410), melanoma (NCT03101254), and solid tumors (NCT02718911); and BLZ945 (4-[2((1R,2R)-2-hydroxycyclohexylamino)-benzothiazol-6-yloxyl]-pyridine-2-carboxylic acid
  • Checkpoint inhibitors that may be used in the present invention include NKG2A receptor inhibitors.
  • NKG2A receptor inhibitors that are being studied in clinical trials include monalizumab (IPH2201, Innate Pharma), an anti-NKG2A antibody, in head and neck neoplasms (NCT02643550) and chronic lymphocytic leukemia (NCT02557516).
  • the immune checkpoint inhibitor is selected from nivolumab, pembrolizumab, ipilimumab, avelumab, durvalumab, atezolizumab, or pidilizumab.
  • the invention provides a composition comprising an agent that inhibits EP4 activity, an immuno-oncology agent, and a pharmaceutically acceptable carrier, adjuvant, or vehicle.
  • the amount of an agent that inhibits EP4 activity in compositions of this invention is such that is effective to measurably inhibit EP4 activity, or a mutant thereof, in a biological sample or in a patient.
  • a composition of this invention is formulated for administration to a patient in need of such composition.
  • a composition of this invention is formulated for oral administration to a patient.
  • an agent that inhibits prostaglandin EP4 receptor (EP4) activity is compound A, or a pharmaceutically acceptable salt thereof.
  • an agent that inhibits prostaglandin EP4 receptor (EP4) activity is compound B, or a pharmaceutically acceptable salt thereof.
  • patient means an animal, preferably a mammal, and most preferably a human.
  • compositions of this invention refers to a non-toxic carrier, adjuvant, or vehicle that does not destroy the pharmacological activity of the compound with which it is formulated.
  • Pharmaceutically acceptable carriers, adjuvants or vehicles that may be used in the compositions of this invention include, but are not limited to, ion exchangers, alumina, aluminum stearate, lecithin, serum proteins, such as human serum albumin, buffer substances such as phosphates, glycine, sorbic acid, potassium sorbate, partial glyceride mixtures of saturated vegetable fatty acids, water, salts or electrolytes, such as protamine sulfate, disodium hydrogen phosphate, potassium hydrogen phosphate, sodium chloride, zinc salts, colloidal silica, magnesium trisilicate, polyvinyl pyrrolidone, cellulose-based substances, polyethylene glycol, sodium carboxymethylcellulose, polyacrylates, waxes, polyethylene-polyoxypropylene-block
  • compositions of the present invention may be administered orally, parenterally, by inhalation spray, topically, rectally, nasally, buccally, vaginally or via an implanted reservoir.
  • parenteral as used herein includes subcutaneous, intravenous, intramuscular, intra-articular, intra-synovial, intrasternal, intrathecal, intrahepatic, intralesional and intracranial injection or infusion techniques.
  • the compositions are administered orally, intraperitoneally or intravenously.
  • Sterile injectable forms of the compositions of this invention may be aqueous or oleaginous suspension. These suspensions may be formulated according to techniques known in the art using suitable dispersing or wetting agents and suspending agents.
  • the sterile injectable preparation may also be a sterile injectable solution or suspension in a non-toxic parenterally acceptable diluent or solvent, for example as a solution in 1,3-butanediol.
  • a non-toxic parenterally acceptable diluent or solvent for example as a solution in 1,3-butanediol.
  • acceptable vehicles and solvents that may be employed are water, Ringer's solution and isotonic sodium chloride solution.
  • sterile, fixed oils are conventionally employed as a solvent or suspending medium.
  • any bland fixed oil may be employed including synthetic mono- or di-glycerides.
  • Fatty acids such as oleic acid and its glyceride derivatives are useful in the preparation of injectables, as are natural pharmaceutically-acceptable oils, such as olive oil or castor oil, especially in their polyoxyethylated versions.
  • These oil solutions or suspensions may also contain a long-chain alcohol diluent or dispersant, such as carboxymethyl cellulose or similar dispersing agents that are commonly used in the formulation of pharmaceutically acceptable dosage forms including emulsions and suspensions.
  • Other commonly used surfactants such as Tweens, Spans and other emulsifying agents or bioavailability enhancers which are commonly used in the manufacture of pharmaceutically acceptable solid, liquid, or other dosage forms may also be used for the purposes of formulation.
  • compositions of this invention may be orally administered in any orally acceptable dosage form including, but not limited to, capsules, tablets, aqueous suspensions or solutions.
  • carriers commonly used include lactose and corn starch.
  • Lubricating agents such as magnesium stearate, are also typically added.
  • useful diluents include lactose and dried cornstarch.
  • aqueous suspensions are required for oral use, the active ingredient is combined with emulsifying and suspending agents. If desired, certain sweetening, flavoring or coloring agents may also be added.
  • compositions of this invention may be administered in the form of suppositories for rectal administration.
  • suppositories for rectal administration.
  • suppositories can be prepared by mixing the agent with a suitable non-irritating excipient that is solid at room temperature but liquid at rectal temperature and therefore will melt in the rectum to release the drug.
  • suitable non-irritating excipient include cocoa butter, beeswax and polyethylene glycols.
  • compositions of this invention may also be administered topically, especially when the target of treatment includes areas or organs readily accessible by topical application, including diseases of the eye, the skin, or the lower intestinal tract. Suitable topical formulations are readily prepared for each of these areas or organs.
  • Topical application for the lower intestinal tract can be effected in a rectal suppository formulation (see above) or in a suitable enema formulation. Topically-transdermal patches may also be used.
  • compositions may be formulated in a suitable ointment containing the active component suspended or dissolved in one or more carriers.
  • Carriers for topical administration of compounds of this invention include, but are not limited to, mineral oil, liquid petrolatum, white petrolatum, propylene glycol, polyoxyethylene, polyoxypropylene compound, emulsifying wax and water.
  • provided pharmaceutically acceptable compositions can be formulated in a suitable lotion or cream containing the active components suspended or dissolved in one or more pharmaceutically acceptable carriers.
  • Suitable carriers include, but are not limited to, mineral oil, sorbitan monostearate, polysorbate 60, cetyl esters wax, cetearyl alcohol, 2-octyldodecanol, benzyl alcohol and water.
  • compositions may be formulated as micronized suspensions in isotonic, pH adjusted sterile saline, or, preferably, as solutions in isotonic, pH adjusted sterile saline, either with or without a preservative such as benzylalkonium chloride.
  • the pharmaceutically acceptable compositions may be formulated in an ointment such as petrolatum.
  • compositions of this invention are formulated for oral administration. Such formulations may be administered with or without food. In some embodiments, pharmaceutically acceptable compositions of this invention are administered without food. In other embodiments, pharmaceutically acceptable compositions of this invention are administered with food.
  • compositions of the present invention that may be combined with the carrier materials to produce a composition in a single dosage form will vary depending upon the host treated, the particular mode of administration.
  • provided compositions should be formulated so that a dosage of between 0.01-100 mg/kg body weight/day of the inhibitor can be administered to a patient receiving these compositions.
  • a specific dosage and treatment regimen for any particular patient will depend upon a variety of factors, including the activity of the specific compound employed, the age, body weight, general health, sex, diet, time of administration, rate of excretion, drug combination, and the judgment of the treating physician and the severity of the particular disease being treated.
  • the amount of a compound of the present invention in the composition will also depend upon the particular compound in the composition.
  • an agent that inhibits EP4 activity and an immuno-oncology agent as described herein are administered in a single composition as a single dosage form.
  • an agent that inhibits EP4 activity and an immuno-oncology agent as described herein are administered separately as a multiple dosage regimen. If administered as a multiple dosage regime, the two agents may be administered simultaneously, sequentially or within a period of time from one another, for example within 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 18, 20, 21, 22, 23, or 24 hours from one another. In some embodiments, the two agents are administerd as a multiple dosage regimen within greater than 24 hours aparts.
  • an agent that inhibits EP4 activity is compound A, or a pharmaceutically acceptable salt thereof.
  • an agent that inhibits EP4 activity is compound B, or a pharmaceutically acceptable salt thereof.
  • the term “combination,” “combined,” and related terms refers to the simultaneous or sequential administration of therapeutic agents in accordance with this invention.
  • an agent that inhibits EP4 activity may be administered with an immuno-oncology agent simultaneously or sequentially in separate unit dosage forms; or an agent that inhibits EP4 activity may be administered with an immuno-oncology agent simultaneously in a single unit dosage form.
  • the present invention provides a single unit dosage form comprising an agent that inhibits EP4 activity, an immuno-oncology agent, and a pharmaceutically acceptable carrier, adjuvant, or vehicle.
  • compositions of this invention should be formulated so that a dosage of between 0.01-100 mg/kg body weight/day of each agent can be administered.
  • an agent that inhibits EP4 activity and an immuno-oncology agent may act synergistically. Therefore, the amount of each agent will be less than that required in a monotherapy utilizing only that therapeutic agent.
  • a dosage of between about 50% to about 100% of the amount normally administered of each agent can be administered.
  • each agent is administered at a dosage of about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, or about 95% of the amount normally administered of each agent.
  • the phrase “normally administered” means the amount an FDA approved therapeutic agent is approvided for dosing per the FDA label insert.
  • each agent present in the compositions of this invention will be no more than the amount that would normally be administered in a composition comprising that therapeutic agent as the only active agent. In some embodiments, the amount of each agent in the presently disclosed compositions will range from about 50% to 100% of the amount normally present in a composition comprising that agent as the only therapeutically active agent.
  • an agent that inhibits EP4 activity and/or an immuno-oncology agent as described in, or pharmaceutical compositions thereof may also be incorporated into compositions for coating an implantable medical device, such as prostheses, artificial valves, vascular grafts, stents and catheters.
  • an implantable medical device such as prostheses, artificial valves, vascular grafts, stents and catheters.
  • Vascular stents for example, have been used to overcome restenosis (re-narrowing of the vessel wall after injury).
  • patients using stents or other implantable devices risk clot formation or platelet activation. These unwanted effects may be prevented or mitigated by pre-coating the device with a pharmaceutically acceptable composition comprising a kinase inhibitor.
  • Implantable devices coated with an agent that inhibits EP4 activity and/or an immuno-oncology agent as described in, or pharmaceutical compositions thereof are another embodiment of the present invention.
  • the present invention provides a method for treating a proliferative disorder in a patient comprising administering to the patient an agent that inhibits prostaglandin EP4 receptor (EP4) activity in combination with an immuno-oncology agent, as described herein.
  • a proliferative disorder is a cancer selected from those as described herein.
  • a patient is a cancer patient who has been treated, or is being treated or to be treated, by immunotherapy.
  • a cancer patient is not pregnant or breastfeeding when receiving the instant treatment.
  • a cancer patient does not conceive children when receiving the instant treatment.
  • an agent that inhibits prostaglandin EP4 receptor (EP4) activity is compound A, or a pharmaceutically acceptable salt thereof. In some embodiments, an agent that inhibits prostaglandin EP4 receptor (EP4) activity is compound B, or a pharmaceutically acceptable salt thereof.
  • treatment refers to reversing, alleviating, delaying the onset of, or inhibiting the progress of a disease or disorder, or one or more symptoms thereof, as described herein.
  • treatment may be administered after one or more symptoms have developed.
  • treatment may be administered in the absence of symptoms.
  • treatment may be administered to a susceptible individual prior to the onset of symptoms (e.g., in light of a history of symptoms and/or in light of genetic or other susceptibility factors). Treatment may also be continued after symptoms have resolved, for example to prevent or delay their recurrence.
  • the cancer is non-small cell lung cancer (NSCLC). In some embodiments, the cancer is advanced and/or metastatic NSCLC. In some embodiments, the cancer is ovarian cancer. In some embodiments, the cancer is breast cancer. In some embodiments, the cancer is head and neck cancer. In some embodiments, the cancer is colorectal cancer (CRC). In some embodiments, the cancer is advanced or progressive microsatellite stable (MSS) CRC.
  • NSCLC non-small cell lung cancer
  • the cancer is advanced and/or metastatic NSCLC.
  • the cancer is ovarian cancer. In some embodiments, the cancer is breast cancer. In some embodiments, the cancer is head and neck cancer. In some embodiments, the cancer is colorectal cancer (CRC). In some embodiments, the cancer is advanced or progressive microsatellite stable (MSS) CRC.
  • a cancer patient is a NSCLC patient.
  • a NSCLC patient has been treated by immunotherapy.
  • a NSCLC patient has been treated by PD-1/L1 immunotherapy.
  • a NSCLC patient has been treated by PD-1/L1 immunotherapy for a minimum of 12 weeks.
  • a NSCLC patient has progressed on PD-1/L1 immunotherapy given for a minimum of 12 weeks (aka post-PD-1/L1 NSCLC adenocarcinoma patients).
  • a NSCLC patient has pathologically diagnosed adenocarcinoma histology of NSCLC.
  • a NSCLC patient is an advanced (stage IIIb) and metastatic (stage IV) patient who has progressed clinically and/or radiographically per RECIST 1.1 (Response Evaluation Criteria in Solid Tumors).
  • a NSCLC patient is at least 18 years old.
  • a NSCLC patient has known PD-L1 positive status (>1%). In some embodiments, a NSCLC patient has a measurable disease as per RECIST 1.1. In some embodiments, a NSCLC patient has progression from a prior immunotherapy treatment with a PD-1 or PD-L1 antagonist given for a minimum of 12 weeks. In some embodiments, a prior immunotherapy may have been given with or without chemotherapy and may have been used in any line. In some embodiments, a NSCLC patient has one additional line of intervening chemotherapy following progression.
  • a NSCLC patient has performance status of ECOG 0-1. In some embodiments, a NSCLC patient has ECOG performance status grade 0. In some embodiments, a NSCLC patient has ECOG performance status grade 1. ECOG performance status is discussed in Oken M, Creech R, Tormey D, et al. “Toxicity and response criteria of the Eastern Cooperative Oncology Group” Am J Clin Oncol. 1982; 5:649-655. ECOG performance status grade 0 refers to patients who are fully active, and are able to carry on all pre-disease performance without restriction. ECOG performance status grade 1 refers to patients who are restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work.
  • a NSCLC patient has adequate bone marrow, renal, and hepatic function as follows (within 7 days of starting therapy):
  • a NSCLC patient has recovered to grade 1 or baseline for all clinically significant on-going adverse events (AEs) from prior therapy.
  • AEs on-going adverse events
  • a NSCLC patient does not have recent (within the last 12 months) history of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, or non-infectious interstitial lung disease.
  • IBD inflammatory bowel disease
  • a NSCLC patient does not have current use of nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors within 3 days before treatment initiation or at any time during the study unless used for management of adverse events.
  • NSAIDs nonsteroidal anti-inflammatory drugs
  • COX-2 cyclooxygenase-2
  • a NSCLC patient does not use an aspirin product, or only use it at prophylactic cardiovascular doses.
  • a NSCLC patient does not have recent (within the last 12 months) or current gastrointestinal (GI) ulcer or colitis (other than IBD) or clinically significant autoimmune disease (i.e. severe) requiring continuous systemic immunosuppressive therapy.
  • GI current gastrointestinal
  • colitis other than IBD
  • clinically significant autoimmune disease i.e. severe
  • a NSCLC patient has not received a live vaccine within 30 days prior to the planned first dose of the instant treatment.
  • a NSCLC patient does not have any condition requiring continuous systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 2 weeks prior to first dose of the instant treatment.
  • a NSCLC patient has inhaled or topical steroids and physiological replacement doses of up to 10 mg daily prednisone equivalent in the absence of active autoimmune disease.
  • a NSCLC patient does not have a known EGFR, ALK, or ROS gene alteration.
  • a NSCLC patient has a history of smoking.
  • a NSCLC patient does not have uncontrolled or life-threatening symptomatic concomitant disease (including known symptomatic HIV, symptomatic Hepatitis B and C, or active tuberculosis [TB]).
  • symptomatic concomitant disease including known symptomatic HIV, symptomatic Hepatitis B and C, or active tuberculosis [TB]).
  • a NSCLC patient has not received chemotherapy or an investigational agent or device, or undergone a major surgery or systemic radiation within 3 weeks of starting the instant treatment, or had inadequate healing or recovery from complications of any of these prior to starting the instant treatment.
  • a NSCLC patient has not had potentially life-threatening second malignancy within 3 years before starting the instant treatment.
  • a NSCLC patient does not have clinically unstable central nervous system (CNS)/brain metastasis (treated or stable CNS metastases allowed).
  • CNS central nervous system
  • a NSCLC patient does not have any other concurrent antineoplastic treatment except for allowed local radiation of lesions for palliation (to be considered non-target lesions after treatment).
  • a NSCLC patient does not have clinically significant (i.e., active) cardiovascular disease, including but not being limited to:
  • a NSCLC patient does not have medical conditions requiring concomitant administration of strong CYP3A4 or P-glycoprotein inhibitors or inducers.
  • a NSCLC patient is not pregnant or breastfeeding, or expecting to conceive children during the instant treatment.
  • a NSCLC patient is with advanced or metastatic Post-PD-1/L1 Non-Small Cell Lung Cancer (NSCLC) adenocarcinoma.
  • NSCLC Non-Small Cell Lung Cancer
  • a NSCLC patient is an adult patient diagnosed with NSCLC who has been previously treated for a minimum of 12 weeks with any PD-1 or PD-L1 checkpoint inhibitor.
  • a NSCLC patient is treated with grapiprant at a starting dose level of 300 mg twice a day (BID). In some embodiments, a NSCLC patient is treated with grapiprant and pembrolizumab for up to 2 years.
  • a NSCLC patient is an adult patient with a histologically confirmed non-small cell lung cancer (NSCLC) adenocarcinoma.
  • NSCLC non-small cell lung cancer
  • a NSCLC patient has an advanced (stage IIIb) disease that is not amenable to curative intent treatment with concurrent chemoradiation and metastatic (stage IV) patients.
  • a NSCLC patient has progressed clinically and/or radiographically per RECIST v1.1 after receiving a PD-1 or PD-L1 antagonist for a minimum of 12 weeks.
  • a NSCLC patient has received Immunotherapy with chemotherapy.
  • a NSCLC patient has received Immunotherapy without chemotherapy.
  • a NSCLC patient has received Immunotherapy in any line.
  • a NSCLC patient has received no more than one prior regimen of immunotherapy.
  • a NSCLC patient has measurable disease per RECIST v1.1 as assessed by the local site investigator/radiology.
  • lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions.
  • a NSCLC patient has a disease that can be safely accessed via bronchoscopic, thoracoscopic or percutaneous biopsy for multiple core biopsies (minimum of 3 passes per biopsy).
  • a NSCLC patient has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
  • ECOG Eastern Cooperative Oncology Group
  • a NSCLC patient has adequate organ function as defined in Table A below.
  • a NSCLC patient does not use NSAIDs (eg, ibuprophen, naproxen), COX-2 inhibitors (eg, celecoxib) within 3 days before treatment initiation or at any time during the treatment.
  • NSAIDs eg, ibuprophen, naproxen
  • COX-2 inhibitors eg, celecoxib
  • a NSCLC patient uses Aspirin products that is limited to prophylactic cardiovascular doses.
  • a NSCLC patient does not have a known epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), or ROS gene alteration.
  • EGFR epidermal growth factor receptor
  • ALK anaplastic lymphoma kinase
  • ROS gene alteration e.g., ROS gene alteration
  • a NSCLC patient does not have a known BRAF gene mutation.
  • a NSCLC patient has a history of smoking (>100 cigarettes lifetime).
  • a NSCLC patient does not have a history of severe hypersensitivity reactions to a PD-1/L1 antibody.
  • a NSCLC patient has not received prior systemic anti-cancer therapy including investigational agents within 4 weeks prior to treatment.
  • a NSCLC patient has recovered from all AEs due to previous therapies to ⁇ Grade 1 or baseline.
  • a NSCLC patient has ⁇ Grade 2 neuropathy.
  • a NSCLC patient has not received prior radiotherapy within 2 weeks of start of a treatment of the invention.
  • a NSCLC patient has recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis.
  • a NSCLC patient has a 1-week washout for palliative radiation ( ⁇ 2 weeks of radiotherapy) to non-central nervous system (CNS) disease.
  • a NSCLC patient does not receive any antineoplastic treatment during a treatment of the invention, except for allowed local radiation of lesions for palliation only (to be considered non-target lesions after treatment).
  • a NSCLC patient has received a surgery, and recovered fully from the toxicity and/or complications from the intervention prior to starting a treatment of the invention.
  • a NSCLC patient has not received a live vaccine within 30 days prior to the first dose of study treatment.
  • a NSCLC patient has not taken strong CYP3A4 or P-glycoprotein inhibitors or inducers prior to and during a treatment of the invention. In some embodiments, a NSCLC patient has taken strong CYP3A4 or P-glycoprotein inhibitors or inducers, but transferred to other medications within ⁇ 5 half-lives prior to dosing of a treatment of the invention.
  • a NSCLC patient does not participate in or has not participated in a study of an investigational agent within 4 weeks prior to the first dose of a treatment of the invention. In some embodiments, a NSCLC patient has not used an investigational device within 4 weeks prior to the first dose of a treatment of the invention.
  • a NSCLC patient does not have a diagnosis of immunodeficiency.
  • a NSCLC patient is not receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent), or any other form of immunosuppressive therapy, within 7 days prior the first dose of a treatment of the invention.
  • a NSCLC patient does not have a known additional potentially life-threatening malignancy that is progressing or has required active treatment within 3 years prior to the first dose of a treatment of the invention.
  • a NSCLC patient has a basal cell carcinoma of the skin.
  • a NSCLC patient has squamous cell carcinoma of the skin.
  • a NSCLC patient has carcinoma in situ (eg, breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy.
  • a NSCLC patient does not have known active CNS metastases and/or carcinomatous meningitis (clinically stable and/or previously treated inactive CNS metastases allowed).
  • a NSCLC patient does not have an active autoimmune disease that has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs).
  • a systemic treatment is not replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency).
  • an autoimmune disease is inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis.
  • a NSCLC patient does not have a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
  • a NSCLC patient does not have an active infection requiring systemic therapy.
  • a NSCLC patient does not have recent (within the last 12 months) or current GI ulcer or colitis or non-immune colitis.
  • a NSCLC patient does not have a known history of human immunodeficiency virus (HIV) infection.
  • HIV human immunodeficiency virus
  • a NSCLC patient does not have a known history of Hepatitis B or known active Hepatitis C virus infection.
  • a NSCLC patient does not have clinically significant (ie, active) cardiovascular disease: cerebral vascular accident/stroke ( ⁇ 6 months prior to enrollment), myocardial infarction ( ⁇ 6 months prior to enrollment), unstable angina, congestive heart failure ( ⁇ New York Heart Association Classification Class II), or uncontrolled cardiac arrhythmia.
  • active cardiovascular disease cerebral vascular accident/stroke ( ⁇ 6 months prior to enrollment), myocardial infarction ( ⁇ 6 months prior to enrollment), unstable angina, congestive heart failure ( ⁇ New York Heart Association Classification Class II), or uncontrolled cardiac arrhythmia.
  • a NSCLC patient does not have a known psychiatric or substance abuse disorder that would interfere with cooperating with a treatment of the invention.
  • a NSCLC patient is not a woman of childbearing potential (WOCBP) who has a positive pregnancy test prior to a treatment of the invention.
  • WOCBP childbearing potential
  • a NSCLC patient is not breastfeeding or expecting to conceive or father children within the projected duration of a treatment of the invention.
  • a CRC patient is histologically confirmed advanced, metastatic, or progressive colorectal cancer (CRC).
  • CRC histologically confirmed advanced, metastatic, or progressive colorectal cancer
  • MSS microsatellite stable disease
  • a CRC patient is at least 18 years old.
  • a CRC patient has progressed on first line 5-FU based therapy, refused therapy or is intolerable to 5-FU based therapy.
  • a CRC patient has a measurable disease as per RECIST 1.1 (Response Evaluation Criteria in Solid Tumors).
  • a CRC patient has a performance status of ECOG 0-1. In some embodiments, a CRC patient has ECOG performance status grade 0. In some embodiments, a CRC patient has ECOG performance status grade 1.
  • a CRC patient has adequate bone marrow, renal, and hepatic function as follows (within 7 days of starting therapy):
  • a CRC patient has recovered to Grade 1 or baseline for all clinically significant on-going adverse events (AEs) from prior therapy.
  • AEs on-going adverse events
  • a CRC patient has completed previous treatment (including other investigational therapy) at least 3 weeks before initiation of the instant treatment.
  • a CRC patient has not been treated with an anti-PD-1, anti-PD-L1, or anti-PD-L2 therapeutic antibody.
  • a CRC patient has not used nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors within 3 days before initiation of the instant treatment, or at any time during the instant treatment, unless used for management of AE.
  • NSAIDs nonsteroidal anti-inflammatory drugs
  • COX-2 cyclooxygenase-2
  • a CRC patient does not use any aspirin product, or only use it at prophylactic cardiovascular doses.
  • a CRC patient does not have a recent (within the last 12 months) history of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, or non-infectious interstitial lung disease.
  • IBD inflammatory bowel disease
  • a CRC patient does not have recent (within the last 12 months) or current gastrointestinal (GI) ulcer or colitis (other than IBD) or clinically significant autoimmune disease (i.e. severe) requiring continuous systemic immunosuppressive therapy.
  • GI current gastrointestinal
  • colitis other than IBD
  • clinically significant autoimmune disease i.e. severe
  • a CRC patient does not have any condition requiring continuous systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 2 weeks prior to first dose of the instant treatment.
  • a CRC patient takes inhaled or topical steroids and physiological replacement doses of up to 10 mg daily prednisone equivalent in the absence of active clinically significant (severe) autoimmune disease.
  • a CRC patient does not have a history of severe hypersensitivity reactions to chimeric or humanized antibodies.
  • a CRC patient has not received a live vaccine within 30 days prior to the first dose of the instant treatment.
  • a CRC patient does not receive any other concurrent antineoplastic treatment except for allowed local radiation of lesions for palliation only (to be considered non-target lesions after treatment).
  • a CRC patient does not have uncontrolled or life-threatening symptomatic concomitant disease (including known symptomatic HIV, symptomatic Hepatitis B and C, or active tuberculosis [TB]).
  • symptomatic concomitant disease including known symptomatic HIV, symptomatic Hepatitis B and C, or active tuberculosis [TB]).
  • a CRC patient has not undergone a major surgery or systemic radiation within 3 weeks of starting the instant treatment or has inadequate healing or recovery from complications of surgery or radiation prior to starting the instant treatment.
  • a CRC patient has not had a potentially life-threatening second malignancy within the last 3 years.
  • a CRC patient does not have clinically unstable central nervous system (CNS)/brain metastasis (treated or stable CNS metastases allowed).
  • CNS central nervous system
  • a CRC patient has not had a clinically significant (i.e., active) cardiovascular disease, including but not being limited to:
  • a CRC patient does not have medical conditions requiring concomitant administration of strong CYP3A4 or P-glycoprotein inhibitors or inducers.
  • a CRC patient is with advanced or progressive MSS CRC.
  • a CRC patient is treated at a starting dose of Grapiprant 300 mg administered orally twice a day (BID).
  • a CRC patient is treated with grapiprant 300 mg administered orally BID, and pembrolizumab administered 200 mg IV every 3 weeks (Q3W).
  • a CRC patient is an adult patient with a histologically confirmed advanced, metastatic, or progressive CRC that is MSS.
  • microsatellite stability is based on prior polymerase chain reaction (PCR), Next-Gen sequencing, or immunohistochemistry results per institutional standards.
  • a CRC patient has received at least two prior lines of therapy for advanced or metastatic CRC, at least one of which included fluorouracil. In some embodiments, a CRC patient has received adjuvant therapy, and progression occurs within 6 months of its completion.
  • a CRC patient has measurable disease per RECIST v1.1 as assessed by the local site investigator/radiology.
  • lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions.
  • a CRC patient has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
  • EOG Eastern Cooperative Oncology Group
  • a CRC patient is able to swallow and absorb oral tablets.
  • a CRC patient is a woman who is not postmenopausal and uses contraception, or a man.
  • a CRC patient has not received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX 40, CD137).
  • an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX 40, CD137).
  • another stimulatory or co-inhibitory T-cell receptor eg, CTLA-4, OX 40, CD137.
  • a CRC patient does not have history of severe hypersensitivity reactions to chimeric or humanized antibodies.
  • a CRC patient has not received prior systemic anti-cancer therapy including investigational agents within 4 weeks (or 5 half-lives, whichever is shorter) prior to a treatment of the invention.
  • a CRC patient has recovered from all AEs due to previous therapies to ⁇ Grade 1 or baseline.
  • a CRC patient is with ⁇ Grade 2 neuropathy.
  • a CRC patient has received major surgery, and has fully recovered from the toxicity and/or complications from the intervention prior to starting a treatment of the invention.
  • a CRC patient has not received a live vaccine within 30 days prior to the first dose of a treatment of the invention.
  • a CRC patient does not participate in, or has not participated in, a study of an investigational agent within 4 weeks prior to the first dose of a treatment of the invention. In some embodiments, a CRC patient has not used an investigational device within 4 weeks prior to the first dose of a treatment of the invention.
  • a CRC patient does not have a diagnosis of immunodeficiency. In some embodiments, a CRC patient does not receive chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent), or any other form of immunosuppressive therapy, within 7 days prior to the first dose of a treatment of the invention.
  • a CRC patient does not have a known additional potentially life-threatening malignancy that is progressing or has required active treatment within 3 years prior to start of a treatment of the invention.
  • a CRC patient has basal cell carcinoma of the skin.
  • a CRC patient has squamous cell carcinoma of the skin.
  • a CRC patient has carcinoma in situ (eg, breast carcinoma, cervical cancer in situ) that has undergone potentially curative therapy.
  • a CRC patient does not have an active autoimmune disease that has required systemic treatment (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs) in 2 years prior to start of a treatment of the invention.
  • a CRC patient has received replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) in 2 years prior to start of a treatment of the invention.
  • an autoimmune disease includes but is not limited to inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis.
  • IBD inflammatory bowel disease
  • a CRC patient does not have an active infection requiring systemic therapy.
  • a CRC patient does not have recent (within 12 months from start of a treatment of the invention) or current GI ulcer or non-immune colitis.
  • a CRC patient does not have a known history of human immunodeficiency virus (HIV) infection.
  • HIV human immunodeficiency virus
  • a CRC patient does not have clinically significant (ie, active) cardiovascular disease: cerebral vascular accident/stroke ( ⁇ 6 months prior to enrollment), myocardial infarction ( ⁇ 6 months prior to enrollment), unstable angina, congestive heart failure ( ⁇ New York Heart Association Classification Class II), or uncontrolled cardiac arrhythmia.
  • active cardiovascular disease cerebral vascular accident/stroke ( ⁇ 6 months prior to enrollment), myocardial infarction ( ⁇ 6 months prior to enrollment), unstable angina, congestive heart failure ( ⁇ New York Heart Association Classification Class II), or uncontrolled cardiac arrhythmia.
  • a CRC patient does not have a known psychiatric or substance abuse disorder that would interfere with cooperating with a treatment of the invention.
  • a CRC patient is not a woman of childbearing potential (WOCBP) who has a positive pregnancy test prior to a treatment of the invention.
  • WOCBP childbearing potential
  • a CRC patient does not breastfeed or expect to conceive or father children within a treatment of the invention.
  • Cancer includes, in some embodiments, without limitation, leukemias (e.g., acute leukemia, acute lymphocytic leukemia, acute myelocytic leukemia, acute myeloblastic leukemia, acute promyelocytic leukemia, acute myelomonocytic leukemia, acute monocytic leukemia, acute erythroleukemia, chronic leukemia, chronic myelocytic leukemia, chronic lymphocytic leukemia), polycythemia vera, lymphoma (e.g., Hodgkin's disease or non-Hodgkin's disease), Waldenstrom's macroglobulinemia, multiple myeloma, heavy chain disease, and solid tumors such as sarcomas and carcinomas (e.g., fibrosarcoma, myxosarcoma, liposarcoma, chondrosarcoma, osteogenic sarcoma, chordoma, angiosarcoma, end
  • the cancer is glioma, astrocytoma, glioblastoma multiforme (GBM, also known as glioblastoma), medulloblastoma, craniopharyngioma, ependymoma, pinealoma, hemangioblastoma, acoustic neuroma, oligodendroglioma, schwannoma, neurofibrosarcoma, meningioma, melanoma, neuroblastoma, or retinoblastoma.
  • GBM glioblastoma multiforme
  • medulloblastoma craniopharyngioma
  • ependymoma pinealoma
  • hemangioblastoma acoustic neuroma
  • oligodendroglioma schwannoma
  • neurofibrosarcoma meningioma, melanoma
  • neuroblastoma
  • the cancer is acoustic neuroma, astrocytoma (e.g. Grade I—Pilocytic Astrocytoma, Grade II—Low-grade Astrocytoma, Grade III—Anaplastic Astrocytoma, or Grade IV—Glioblastoma (GBM)), chordoma, CNS lymphoma, craniopharyngioma, brain stem glioma, ependymoma, mixed glioma, optic nerve glioma, subependymoma, medulloblastoma, meningioma, metastatic brain tumor, oligodendroglioma, pituitary tumors, primitive neuroectodermal (PNET) tumor, or schwannoma.
  • astrocytoma e.g. Grade I—Pilocytic Astrocytoma, Grade II—Low-grade Astrocytoma, Grade III—Anaplastic Astrocytoma, or Grade IV—G
  • the cancer is a type found more commonly in children than adults, such as brain stem glioma, craniopharyngioma, ependymoma, juvenile pilocytic astrocytoma (JPA), medulloblastoma, optic nerve glioma, pineal tumor, primitive neuroectodermal tumors (PNET), or rhabdoid tumor.
  • the patient is an adult human. In some embodiments, the patient is a child or pediatric patient.
  • Cancer includes, in another embodiment, without limitation, mesothelioma, hepatobilliary (hepatic and billiary duct), bone cancer, pancreatic cancer, skin cancer, cancer of the head or neck, cutaneous or intraocular melanoma, ovarian cancer, colon cancer, rectal cancer, cancer of the anal region, stomach cancer, gastrointestinal (gastric, colorectal, and duodenal), uterine cancer, carcinoma of the fallopian tubes, carcinoma of the endometrium, carcinoma of the cervix, carcinoma of the vagina, carcinoma of the vulva, Hodgkin's Disease, cancer of the esophagus, cancer of the small intestine, cancer of the endocrine system, cancer of the thyroid gland, cancer of the parathyroid gland, cancer of the adrenal gland, sarcoma of soft tissue, cancer of the urethra, cancer of the penis, prostate cancer, testicular cancer, chronic or acute leukemia, chronic myeloid leukemia, lymphocy
  • the cancer is selected from hepatocellular carcinoma, ovarian cancer, ovarian epithelial cancer, or fallopian tube cancer; papillary serous cystadenocarcinoma or uterine papillary serous carcinoma (UPSC); prostate cancer; testicular cancer; gallbladder cancer; hepatocholangiocarcinoma; soft tissue and bone synovial sarcoma; rhabdomyosarcoma; osteosarcoma; chondrosarcoma; Ewing sarcoma; anaplastic thyroid cancer; adrenocortical adenoma; pancreatic cancer; pancreatic ductal carcinoma or pancreatic adenocarcinoma; gastrointestinal/stomach (GIST) cancer; lymphoma; squamous cell carcinoma of the head and neck (SCCHN); salivary gland cancer; glioma, or brain cancer; neurofibromatosis-1 associated malignant peripheral nerve sheath tumors (MPNST); Walden
  • the cancer is selected from hepatocellular carcinoma (HCC), hepatoblastoma, colon cancer, rectal cancer, ovarian cancer, ovarian epithelial cancer, fallopian tube cancer, papillary serous cystadenocarcinoma, uterine papillary serous carcinoma (UPSC), hepatocholangiocarcinoma, soft tissue and bone synovial sarcoma, rhabdomyosarcoma, osteosarcoma, anaplastic thyroid cancer, adrenocortical adenoma, pancreatic cancer, pancreatic ductal carcinoma, pancreatic adenocarcinoma, glioma, neurofibromatosis-1 associated malignant peripheral nerve sheath tumors (MPNST), Waldenstrom's macroglobulinemia, or medulloblastoma.
  • HCC hepatocellular carcinoma
  • hepatoblastoma colon cancer
  • rectal cancer ovarian cancer
  • the cancer is a solid tumor, such as a sarcoma, carcinoma, or lymphoma.
  • Solid tumors generally comprise an abnormal mass of tissue that typically does not include cysts or liquid areas.
  • the cancer is selected from renal cell carcinoma, or kidney cancer; hepatocellular carcinoma (HCC) or hepatoblastoma, or liver cancer; melanoma; breast cancer; colorectal carcinoma, or colorectal cancer; colon cancer; rectal cancer; anal cancer; lung cancer, such as non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC); ovarian cancer, ovarian epithelial cancer, ovarian carcinoma, or fallopian tube cancer; papillary serous cystadenocarcinoma or uterine papillary serous carcinoma (UPSC); prostate cancer; testicular cancer; gallbladder cancer; hepatocholangiocarcinoma; soft tissue and bone synovial sarcoma; rhabdomyosarcoma;
  • HCC
  • the cancer is selected from hepatocellular carcinoma (HCC), hepatoblastoma, colon cancer, rectal cancer, ovarian cancer, ovarian epithelial cancer, ovarian carcinoma, fallopian tube cancer, papillary serous cystadenocarcinoma, uterine papillary serous carcinoma (UPSC), hepatocholangiocarcinoma, soft tissue and bone synovial sarcoma, rhabdomyosarcoma, osteosarcoma, anaplastic thyroid cancer, adrenocortical carcinoma, pancreatic cancer, pancreatic ductal carcinoma, pancreatic adenocarcinoma, glioma, neurofibromatosis-1 associated malignant peripheral nerve sheath tumors (MPNST), Waldenstrom's macroglobulinemia, or medulloblastoma.
  • HCC hepatocellular carcinoma
  • hepatoblastoma colon cancer
  • rectal cancer ovarian cancer
  • ovarian cancer ova
  • the cancer is hepatocellular carcinoma (HCC). In some embodiments, the cancer is hepatoblastoma. In some embodiments, the cancer is colon cancer. In some embodiments, the cancer is rectal cancer. In some embodiments, the cancer is ovarian cancer, or ovarian carcinoma. In some embodiments, the cancer is ovarian epithelial cancer. In some embodiments, the cancer is fallopian tube cancer. In some embodiments, the cancer is papillary serous cystadenocarcinoma. In some embodiments, the cancer is uterine papillary serous carcinoma (UPSC). In some embodiments, the cancer is hepatocholangiocarcinoma. In some embodiments, the cancer is soft tissue and bone synovial sarcoma.
  • HCC hepatocellular carcinoma
  • the cancer is hepatoblastoma. In some embodiments, the cancer is colon cancer. In some embodiments, the cancer is rectal cancer. In some embodiments, the cancer is ovarian cancer, or ovarian carcinoma. In
  • the cancer is Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Adrenocortical Carcinoma, Anal Cancer, Appendix Cancer, Atypical Teratoid/Rhabdoid Tumor, Basal Cell Carcinoma, Bile Duct Cancer, Bladder Cancer, Bone Cancer, Brain Tumor, Astrocytoma, Brain and Spinal Cord Tumor, Brain Stem Glioma, Central Nervous System Atypical Teratoid/Rhabdoid Tumor, Central Nervous System Embryonal Tumors, Breast Cancer, Bronchial Tumors, Burkitt Lymphoma, Carcinoid Tumor, Carcinoma of Unknown Primary, Central Nervous System Cancer, Cervical Cancer, Childhood Cancers, Chordoma, Chronic Lymphocytic Leukemia (CLL), Chronic Myelogenous Leukemia (CML), Chronic Myeloproliferative Disorders, Colon Cancer, Colorectal Cancer, Craniophary
  • the cancer is small cell lung cancer, non-small cell lung cancer, colorectal cancer, multiple myeloma, acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), pancreatic cancer, liver cancer, hepatocellular cancer, neuroblastoma, other solid tumors or other hematological cancers.
  • AML acute myeloid leukemia
  • ALL acute lymphoblastic leukemia
  • pancreatic cancer liver cancer, hepatocellular cancer, neuroblastoma, other solid tumors or other hematological cancers.
  • the cancer is small cell lung cancer, non-small cell lung cancer, colorectal cancer, multiple myeloma, or AML.
  • the present invention further features methods and compositions for the diagnosis, prognosis and treatment of viral-associated cancers, including human immunodeficiency virus (HIV) associated solid tumors, human papilloma virus (HPV)-16 positive incurable solid tumors, and adult T-cell leukemia, which is caused by human T-cell leukemia virus type I (HTLV-I) and is a highly aggressive form of CD4+ T-cell leukemia characterized by clonal integration of HTLV-I in leukemic cells (See https://clinicaltrials.gov/ct2/show/study/NCT02631746); as well as virus-associated tumors in gastric cancer, nasopharyngeal carcinoma, cervical cancer, vaginal cancer, vulvar cancer, squamous cell carcinoma of the head and neck, and Merkel cell carcinoma.
  • HSV human immunodeficiency virus
  • HPV human papilloma virus
  • HTLV-I human T-cell leukemia virus type I
  • the present invention provides a method for treating a tumor in a patient in need thereof, comprising administering to the patient an agent that inhibits prostaglandin EP4 receptor (EP4) activity and an immuno-oncology agent as described herein, or pharmaceutical compositions thereof described herein.
  • the tumor comprises any of the cancers described herein.
  • the tumor comprises melanoma cancer.
  • the tumor comprises breast cancer.
  • the tumor comprises lung cancer.
  • the tumor comprises small cell lung cancer (SCLC).
  • the tumor comprises non-small cell lung cancer (NSCLC).
  • the tumor is treated by arresting further growth of the tumor.
  • the tumor is treated by reducing the size (e.g., volume or mass) of the tumor by at least 5%, 10%, 25%, 50%, 75%, 90% or 99% relative to the size of the tumor prior to treatment.
  • tumors are treated by reducing the quantity of the tumors in the patient by at least 5%, 10%, 25%, 50%, 75%, 90% or 99% relative to the quantity of tumors prior to treatment.
  • the compounds and compositions, according to the method of the present invention may be administered using any amount and any route of administration effective for treating or lessening the severity of a cancer.
  • the exact amount required will vary from subject to subject, depending on the species, age, and general condition of the subject, the severity of the disease or condition, the particular agent, its mode of administration, and the like.
  • the compounds and compositions, according to the method of the present invention are preferably formulated in dosage unit form for ease of administration and uniformity of dosage.
  • dosage unit form refers to a physically discrete unit of agent appropriate for the patient to be treated. It will be understood, however, that the total daily usage of the compounds and compositions will be decided by the attending physician within the scope of sound medical judgment.
  • compositions of this invention can be administered to humans and other animals orally, rectally, parenterally, intracisternally, intravaginally, intraperitoneally, topically (as by powders, ointments, or drops), bucally, as an oral or nasal spray, or the like, depending on the severity of the disease or disorder being treated.
  • the compounds of the invention may be administered orally or parenterally at dosage levels of about 0.01 mg/kg to about 50 mg/kg and preferably from about 1 mg/kg to about 25 mg/kg, of subject body weight per day, one or more times a day, to obtain the desired therapeutic effect.
  • Liquid dosage forms for oral administration include, but are not limited to, pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs.
  • the liquid dosage forms may contain inert diluents commonly used in the art such as, for example, water or other solvents, solubilizing agents and emulsifiers such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, dimethylformamide, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor, and sesame oils), glycerol, tetrahydrofurfuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
  • the oral compositions can also include adjuvants such as, for example, water or other solvents, solubil
  • sterile injectable aqueous or oleaginous suspensions may be formulated according to the known art using suitable dispersing or wetting agents and suspending agents.
  • the sterile injectable preparation may also be a sterile injectable solution, suspension or emulsion in a nontoxic parenterally acceptable diluent or solvent, for example, as a solution in 1,3-butanediol.
  • acceptable vehicles and solvents that may be employed are water, Ringer's solution, U.S.P. and isotonic sodium chloride solution.
  • sterile, fixed oils are conventionally employed as a solvent or suspending medium.
  • any bland fixed oil can be employed including synthetic mono- or diglycerides.
  • fatty acids such as oleic acid are used in the preparation of injectables.
  • Injectable formulations can be sterilized, for example, by filtration through a bacterial-retaining filter, or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved or dispersed in sterile water or other sterile injectable medium prior to use.
  • the rate of compound release can be controlled.
  • biodegradable polymers include poly(orthoesters) and poly(anhydrides).
  • Depot injectable formulations are also prepared by entrapping the compound in liposomes or microemulsions that are compatible with body tissues.
  • compositions for rectal or vaginal administration are preferably suppositories which can be prepared by mixing the compounds of this invention with suitable non-irritating excipients or carriers such as cocoa butter, polyethylene glycol or a suppository wax which are solid at ambient temperature but liquid at body temperature and therefore melt in the rectum or vaginal cavity and release the active compound.
  • suitable non-irritating excipients or carriers such as cocoa butter, polyethylene glycol or a suppository wax which are solid at ambient temperature but liquid at body temperature and therefore melt in the rectum or vaginal cavity and release the active compound.
  • Solid dosage forms for oral administration include capsules, tablets, pills, powders, and granules.
  • the active compound is mixed with at least one inert, pharmaceutically acceptable excipient or carrier such as sodium citrate or dicalcium phosphate and/or a) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and silicic acid, b) binders such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidinone, sucrose, and acacia, c) humectants such as glycerol, d) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate, e) solution retarding agents such as paraffin, f) absorption accelerators such as quaternary ammonium compounds, g) wetting agents such as, for example, cetyl alcohol and gly
  • Solid compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polyethylene glycols and the like.
  • the solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings and other coatings well known in the pharmaceutical formulating art. They may optionally contain opacifying agents and can also be of a composition that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner. Examples of embedding compositions that can be used include polymeric substances and waxes. Solid compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polethylene glycols and the like.
  • the active compounds can also be in micro-encapsulated form with one or more excipients as noted above.
  • the solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings, release controlling coatings and other coatings well known in the pharmaceutical formulating art.
  • the active compound may be admixed with at least one inert diluent such as sucrose, lactose or starch.
  • Such dosage forms may also comprise, as is normal practice, additional substances other than inert diluents, e.g., tableting lubricants and other tableting aids such a magnesium stearate and microcrystalline cellulose.
  • the dosage forms may also comprise buffering agents. They may optionally contain opacifying agents and can also be of a composition that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner.
  • buffering agents include polymeric substances and waxes.
  • Dosage forms for topical or transdermal administration of a compound of this invention include ointments, pastes, creams, lotions, gels, powders, solutions, sprays, inhalants or patches.
  • the active component is admixed under sterile conditions with a pharmaceutically acceptable carrier and any needed preservatives or buffers as may be required.
  • Ophthalmic formulation, ear drops, and eye drops are also contemplated as being within the scope of this invention.
  • the present invention contemplates the use of transdermal patches, which have the added advantage of providing controlled delivery of a compound to the body.
  • Such dosage forms can be made by dissolving or dispensing the compound in the proper medium.
  • Absorption enhancers can also be used to increase the flux of the compound across the skin. The rate can be controlled by either providing a rate controlling membrane or by dispersing the compound in a polymer matrix or gel.
  • the agents that inhibit EP4 activity and immuno-oncology agents can be prepared by methods known to one of ordinary skill in the art.
  • the agents that inhibit EP4 activity can be synthesized as described in WO 2002/032900, WO 2005/021508, and U.S. Pat. Nos. 6,710,054 and 7,960,407, the contents of which are incorporated herein by reference in their entireties.
  • Exemplary protocols for preparing polymorph form A of compound A are described in U.S. Pat. Nos. 7,960,407 and 9,265,756, the contents of which are incorporated herein by reference in their entireties.
  • one or more tautomeric forms of compounds of the examples described hereinafter may be prepared in situ and/or isolated. All tautomeric forms of compounds of the examples described hereafter should be considered to be disclosed.
  • the resulting mixture is stirred vigorously at room temperature, then aqueous NaOH solution is added dropwise. After the completion of the addition, pH value of the solution is confirmed to be 5-5.5.
  • the layers are then separated, and the aqueous layer is re-extracted with CH 2 Cl 2 and the organic layer is combined.
  • the organic layer is washed with the mixture of aqueous solution of citric acid and aqueous NaOH solution. After layers are separated, the aqueous layer is re-extracted with CH 2 Cl 2 and the organic layer is combined.
  • the resulting organic layer is added Na 2 SO 4 and of charcoal, and the mixture is stirred gently at room temperature. After the mixture is filtered through celite pad, it is concentrated to give the crude product.
  • Step 1 In a round bottom, 4-necked flask equipped with a mechanical stirrer, thermometer and reflux condenser is immersed in a water bath. In the flask, hot (40° C.) acetone is added to the crude N-[( ⁇ 2-[4-(2-ethyl-4,6-dimethyl-1H-imidazo[4,5-c]pyridin-1-yl)phenyl]ethyl ⁇ amino) carbonyl]-4-methylbenzenesulfonamide (Step 1). The mixture is stirred at 50° C. under nitrogen atmosphere, then cooled slowly to room temperature. Acetone is added and the mixture is stirred at room temperature under nitrogen atmosphere. The crystals are filtered through paper filter, washed with acetone and dried by flowing nitrogen gas to give crystals of the title compound, which are further purified by the following procedure.
  • the reaction is atmospherically concentrated to a minimum stirable volume and displacement continued with speck freed acetone until an internal temperature of 58° C. to 62° C. is achieved.
  • the reaction is cooled to at least 30° C. and seed of N-[( ⁇ 2-[4-(2-Ethyl-4,6-dimethyl-1H-imidazo[4,5-c]pyridin-1-yl)phenyl]ethyl ⁇ amino)carbonyl]-4-methylbenzenesulfonamide Polymorph Form A is added.
  • the reaction is allowed to granulate between 20° C. and 25° C. After cooling reaction to 0° C. to 5° C. and granulating, the reaction is filtered on a speck free filter.
  • the solids are washed two times with speck free acetone cooled to 0° C. to 5° C.
  • the wet-cake is returned to a speck free 3-neck round-bottom flask and speck free ethyl acetate is added.
  • the slurry is heated to at least 75° C. and held for some time.
  • the reaction is cooled to at least 30° C. and the solids are filtered on a speck free filter.
  • the solids are washed with speck free ethyl acetate.
  • the wet-cake is returned to the same speck free 3-neck round-bottom flask and speck free ethyl acetate is added.
  • the slurry is heated to at least 75° C.
  • the reaction is cooled to at least 30° C. and the solids are filtered on a speck free filter. The solids are washed with speck free ethyl acetate. The product is dried at 45° C. to 50° C. to yield the title product, Polymorph Form A.
  • the particle size generated by the above methodology generates a particle size that does not require milling.
  • a simple hand-sieving process removes any lumps.
  • the product is hand sieved through a speck free #25 hand sieve with 0.0278-inch openings.
  • Polymorph form A of compound A is prepared by slurry of Form J of compound A in 1:2 dichloromethane/acetone (v/v) at 25° C.
  • Form J of compound A is a dichloromethane (DCM) solvate, having an unidentified amount of water.
  • Form J crystals are prepared by precipitating compound A in 2:1 dichloromethane/n-heptane (2:1).
  • Example 2 A Phase 1b/2 Study of Grapiprant, an EP4 Inhibitor, and Pembrolizumab, a PD-1 Checkpoint Inhibitor, in Patients with Advanced or Metastatic Post-PD-1/L1 Non-Small Cell Lung Cancer (NSCLC) Adenocarcinoma
  • This study is a multi-center, open-label, single-arm, Phase 1b/2 study to evaluate the safety and efficacy of grapiprant in combination with pembrolizumab in adult patients diagnosed with NSCLC who have been previously treated for a minimum of 12 weeks with any PD-1 or PD-L1 checkpoint inhibitor. Participant enrollment and continuous safety assessment will be dictated by an mTPI model. Decisions for dose escalation and de-escalation will be made by a safety review board (SRB) comprised of enrolling study investigators and the Sponsor. The starting grapiprant dose will be 300 mg twice a day (BID) unless lowered at the study initiation by the SRB.
  • SRB safety review board
  • Dose escalation and confirmation will end after 14 participants have been treated at any of the selected doses found to be acceptable. Following the continuous safety assessment phase, additional participants up to a total trial size of 25 will be enrolled to assess efficacy. Participants, including those who achieve a complete response (CR), may receive treatment with grapiprant and pembrolizumab for up to 2 years or until they experience disease progression with clinical deterioration, unacceptable toxicity, or consent withdrawal, followed by 30- and 90-Day End of Treatment Follow-up visits after their last day of study treatment.
  • CR complete response
  • a cycle of treatment will be defined as every 3 weeks (Q3W).
  • Participants with Grade 2 or greater dyspepsia for 5 or more days may, at the judgment of the investigator, institute ranitidine at 75 mg orally BID, to be taken 2 hours after the dose of grapiprant, until symptoms abate.
  • Participants may receive grapiprant and pembrolizumab until they experience disease progression with clinical deterioration, unacceptable toxicity, or consent withdrawal, followed by 30- and 90-Day End of Treatment Follow-up visits after their last day of study treatment.
  • the duration of the study for each participant will include a Screening period for inclusion in the study of up to 28 days, courses of Combination Treatment cycles repeated every 21 days for a maximum of 35 cycles (up to 2 years), and End of Treatment Follow-up visits at 30 and 90 days following the last day of study treatment administration.
  • the End of Treatment 90-Day Follow-up visit will be considered as the End of Study visit.
  • Dose de-escalation for all participants will take place any time safety rules indicate (eg, if 4 participants or more participants out of the first 6 participants experiences a DLT). Participants already enrolled and receiving drug without severe AEs may be permitted to receive additional doses at the original dose level after discussion with the Sponsor.
  • the expected enrollment period is 15 months.
  • the study cut-off date is defined as the date when all the participants have either completed 16 weeks of treatment (ie, until the second tumor assessment) or discontinued the study treatment. The participants who continue to receive the study treatment after the study cut-off date will be followed and appropriate statistical analysis (listings or updated tables for safety, drug exposure and activity) will be performed when all the participants have discontinued the study treatment.
  • the combination side-effect profile is expected to be similar to pembrolizumab alone.
  • PK parameters of grapiprant will be summarized using descriptive statistics by dose level and time since last dose.
  • the plasma PK of grapiprant will be described for the Cmax and AUC PK parameters. Any additional PK analyses will be described in the statistical analysis plan (SAP).
  • Additional exploratory PK and/or exposure-response modeling may be applied to the data, as appropriate.
  • Results of PK and/or any population PK or exposure-response analyses may be reported outside the clinical study report.
  • Anti-tumor efficacy data will be descriptively presented on the evaluable response population including participants who had a disease assessment at screening and at a minimum one other time point during the study treatment.
  • CIs estimate and confidence intervals
  • Example 3 A Phase 1b Study of Grapiprant, an EP4 Inhibitor, and Pembrolizumab, a PD-1 Checkpoint Inhibitor in Patients with Advanced or Progressive Microsatellite Stable (MSS) Colorectal Cancer (CRC)
  • the study is a multi-center, open-label, single-arm, Phase 1b, safety, and efficacy study of grapiprant in combination with pembrolizumab in adult patients with advanced or progressive MSS CRC.
  • This is the first study combining grapiprant with a PD-1 antibody (pembrolizumab), therefore, participant enrollment and continuous safety assessment will be dictated by an mTPI model.
  • the Combination Treatment period will consist of 35 cycles (up to 2 years).
  • the study also includes a one-week Single Agent Run-in period for the purpose of assessing pharmacodynamics of grapiprant as a single agent, as well as in combination with pembrolizumab in the following Combination Treatment period.
  • Participants enrolled into Cohort 1 will be treated with grapiprant during the Single Agent Run-in period and all participants enrolled into Cohort 1 and Cohort 2 will receive treatment with grapiprant and pembrolizumab during the Combination Treatment period.
  • Approximately 30 patients are planned to be screened for this study to allow up to 15 participants for enrollment into Cohort 1 and up to 10 participants for enrollment into Cohort 2.
  • Cohort 1 will enroll participants prior to enrollment of participants into Cohort 2.
  • enrollment of additional participants, up to a total trial size of 25 participants, will be assessed to establish an estimate of efficacy.
  • Accessible tumor that can be safely accessed for multiple core biopsies and patient is willing to provide tissue from newly obtain biopsies before and during treatment.
  • NSAIDs eg, ibuprophen, naproxen
  • COX-2 inhibitors eg, celecoxib
  • autoimmune disease has required systemic treatment in past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs).
  • Replacement therapy eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency
  • Autoimmune diseases include but are not limited to inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis.
  • HIV human immunodeficiency virus
  • cardiovascular disease cerebral vascular accident/stroke ( ⁇ 6 months prior to enrollment), myocardial infarction ( ⁇ 6 months prior to enrollment), unstable angina, congestive heart failure ( ⁇ New York Heart Association Classification Class II), or uncontrolled cardiac arrhythmia.
  • a cycle of treatment will be defined as Q3W.
  • the pembrolizumab dose will be 200 mg IV Q3W.
  • the dose of grapiprant will be 300 mg administered orally BID (daily dose taken at 8- to 12-hour intervals, preferably with food).
  • Participants with Grade 2 or greater dyspepsia for 5 or more days may, at the judgment of the investigator, institute ranitidine at 75 mg orally BID, to be taken 2 hours after the dose of grapiprant, until abdominal discomfort abates.
  • Participants may receive treatment with grapiprant and pembrolizumab for up to 2 years or until they experience disease progression, unacceptable toxicity, or consent withdrawal, followed by 30- and 90-Day End of Treatment Follow-up visits after their last day of study drug.
  • CR complete response
  • the duration of the study for each participant will include a screening period for inclusion in the study of up to 28 days, a 7-day Single Agent Run-in (for Cohort 1 only), courses of Combination Treatment cycles repeated every 21 days, and End of Treatment follow-up visits at 30 and 90 days following the last study drug administration for all participants. Participants may continue to receive the study drugs for a maximum of 35 cycles (up to 2 years).
  • Dose de-escalation for all participants will take place any time safety rules indicate (eg, if 3 or more participants out of the first 5 participants experiences a DLT). Participants already enrolled and receiving drug without severe AEs may be permitted to receive additional doses at the original dose level after discussion with the Sponsor.
  • the expected enrollment period is 10 months.
  • the study cut-off date is defined as the date when all the participants have either completed 16 weeks of treatment (ie., until the second tumor assessment) or discontinued the study drug. The participants who continue to receive the study drug after the study cut-off date will be followed and appropriate statistical analysis (listings or updated tables for safety, drug exposure and activity) will be performed when all the participants have discontinued the study drug.
  • the combination side-effect profile is expected to be similar to pembrolizumab alone.
  • PK parameters of grapiprant will be summarized using descriptive statistics by dose level and time since last dose.
  • the plasma PK of grapiprant will be described for the Cmax and AUC PK parameters. Any additional PK analyses will be described in the statistical analysis plan (SAP).
  • Additional exploratory PK and/or exposure-response modeling may be applied to the data, as appropriate.
  • Results of PK and/or any population PK or exposure-response analyses may be reported outside the clinical study report.
  • Anti-tumor efficacy data will be descriptively presented on the evaluable response population including participants who had a disease assessment at screening and at a minimum one other time point during the study treatment.

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